{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Timothy P Benoit","gend":0,"currentgend":"","add":"55 HALE ST","city":"PORTLAND","state":"ME","zip":"04103","dob":"1954-02-22","age":"","mstatus":"","insh":"10000067690","cliId":"","pno":2076500117,"cno":"","email":"Tpbenoit54@gmail.com","ename":"","eno":"","pphy":"FUCHS ERTMAN, DEBRA","ppno":2077745816,"pcpadd":"100 GANNETT DRIVE,SUITE C","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"55 HALE ST","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":2078741483,"pcpnpi":1730158403,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5TT1PU6QF97","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J0100","J4520","G4733","L570","Z85828","L718","L821","I10","R413","I739","D649","R10811","R634","R0609","I493","R7989","I498","D500","K5730","M7021","Z0001","Z23","I081","I422","H903","R12","R002","R7401","R059","J069","R062","E876","Z125","E785","R7303","H52223","Z0101","H60501","R6889","I77810","K6389","I83812","I8001","I872","I83811","S51812A","Z87891","R42","L0232","I440","I7120","R791","H9190","R1013","H2513","H5202","R1110","K219","H5203","K429","Z01812","Z20822","R0989","D485","L820","H60502"],"date":["2025-07-22","2025-07-22","2025-10-22","2025-03-05","2025-01-27","2025-01-27","2025-01-27","2023-07-06","2025-07-14","2025-07-14","2025-03-14","2024-09-08","2024-09-08","2023-07-20","2024-01-09","2023-06-05","2023-08-15","2023-12-14","2023-12-14","2025-04-26","2024-12-03","2025-09-16","2023-07-20","2023-07-20","2025-10-06","2023-06-26","2023-06-26","2023-07-19","2024-07-14","2024-07-14","2024-07-14","2023-06-16","2023-11-30","2024-12-12","2024-12-12","2023-01-11","2023-01-11","2025-09-18","2023-03-14","2023-06-09","2023-07-02","2023-03-22","2023-03-22","2023-03-22","2023-03-17","2024-05-23","2024-05-23","2023-06-12","2025-07-26","2023-08-15","2023-07-06","2023-06-05","2025-06-02","2023-07-02","2025-03-17","2024-03-11","2023-07-02","2023-07-02","2025-03-17","2022-04-11","2022-04-08","2022-04-08","2021-11-09","2021-12-21","2021-12-21","2022-01-05"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ARNUITY ELLIPTA","","","Select","Select",""],["","","PULMICORT FLEXHALER","","","Select","Select",""],["","","ADVAIR DISKUS","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUOCINOLONE ACETONIDE OIL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","ADACEL TDAP","","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}