{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David B Witherill","gend":0,"currentgend":"","add":"5 CANDLEWICK LN","city":"Cumberland Center","state":"ME","zip":"04021","dob":"1954-06-09","age":"","mstatus":"","insh":"10000068591","cliId":"","pno":2078293046,"cno":2073180345,"email":"penbaydw@gmail.com","ename":"","eno":"","pphy":"PIERCE, DANIEL C","ppno":2078469013,"pcpadd":"InterMed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5 CANDLEWICK LN","madd2":"","madd3":"","mcity":"Cumberland Center","mstate":"ME","mzip":"04021","pcpfaxno":2078741483,"pcpnpi":1861451080,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5GR2WG0RC83","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M2012","M79672","Q66222","D049","L570","D485","Z85828","L661","Z0101","K219","K589","R4182","R9720","E785","D0439","Z01812","C44310","N401","C4491","R197","H6123","Z0001","S76311A","M25551","H903","K5900","Z125","B351","L603","R051","Z8551","M2011","K30","Z1211","D123","Z0000","R238","R202","N400","K8020","C44629","K4020","M79644","H60331","H6121","Z98890","M67449","R6889","K130","M21611","Z23","M19071","C4441","D225","H6090","R0981","C44311","M25562","M25561","M6281","M25569","M1711","M1712","N3943"],"date":["2024-04-11","2023-10-18","2023-10-18","2023-06-27","2025-10-06","2025-10-06","2023-09-13","2023-09-13","2024-12-17","2025-03-14","2023-10-24","2023-10-24","2025-07-14","2025-05-19","2023-11-02","2023-10-05","2023-12-06","2025-07-14","2023-09-13","2025-05-19","2025-05-23","2025-05-23","2025-04-14","2025-04-14","2025-01-17","2025-03-14","2024-05-15","2024-04-11","2024-04-11","2024-04-01","2024-11-06","2023-04-04","2025-09-15","2025-02-04","2025-02-04","2024-05-21","2024-06-28","2024-07-03","2024-12-03","2025-09-15","2025-11-05","2024-11-27","2023-01-05","2023-08-15","2023-08-15","2023-01-16","2024-12-03","2022-12-13","2022-11-18","2022-10-25","2022-11-02","2022-10-12","2022-09-12","2022-09-12","2022-07-29","2022-07-29","2022-06-23","2022-05-11","2022-05-11","2022-05-11","2022-04-04","2022-04-04","2022-04-04","2022-03-03"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","LANSOPRAZOLE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HC","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}