{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John B Kirk","gend":0,"currentgend":"","add":"10 ASPEN LN","city":"GORHAM","state":"ME","zip":"04038","dob":"1949-08-25","age":"","mstatus":"","insh":"10000069677","cliId":"","pno":2075726690,"cno":2075726690,"email":"Kirkjohnb082549@gmail.com","ename":"","eno":"","pphy":"ZEITLIN, JAMES","ppno":2077745816,"pcpadd":"100 FODEN ROAD WEST,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41062327","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"10 ASPEN LN","madd2":"","madd3":"","mcity":"GORHAM","mstate":"ME","mzip":"04038","pcpfaxno":2078741483,"pcpnpi":1194794859,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4X48D74QY62","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L905","M79651","M79652","L570","L089","L578","D485","I350","Z006","I5031","E785","M109","Z125","L820","R710","I083","S30861A","W57XXXA","N401","B351","L814","S32010S","L821","Z85828","M5450","M9904","R293","Z87820","M25552","M9903","M9906","I081","Z952","K5130","Z0001","Z23","S32010D","Z48812","S7712XD","S7711XD","M47816","M5136","Z01810","R6889","N138","R350","C44310","H903","Z1211","K5150","I361","I5189","Z953","M25561","C44319","R3914","I371","H43813","H02883","H02886","I2510","I2584","Z1212","K529","K6289","M7910","M5442","S40862A","R053","D649","M25551","M7061","M7062","R600","N281","M160","J069","Z8719","Z8572","K219","R4182","M5137","R7989","R0789","H6690","Z961","H6982","L909","L03011","C44519","M79641","C4441","Z79899","I351","Z86010","H2513","H5213","M19071","M7671","H2512","S6981XA","H2511","G4733","I509","C8190","H25042","K5190"],"date":["2022-11-28","2024-09-19","2024-09-19","2025-10-17","2023-09-22","2024-11-05","2023-03-21","2024-06-18","2024-05-23","2024-11-08","2025-08-21","2025-08-21","2025-08-21","2025-10-17","2023-10-16","2024-05-22","2025-05-22","2025-05-22","2025-08-20","2023-09-22","2023-09-22","2022-12-27","2022-11-28","2023-11-08","2023-10-04","2023-10-06","2023-10-04","2023-10-04","2023-10-04","2023-10-06","2023-10-04","2024-05-23","2025-06-26","2023-03-16","2025-08-21","2025-08-21","2022-12-27","2024-05-22","2023-01-05","2023-01-05","2023-01-05","2023-01-05","2024-05-21","2023-11-09","2025-08-20","2025-07-24","2023-05-02","2023-08-14","2023-11-08","2023-11-08","2025-06-23","2025-06-23","2025-06-23","2024-12-26","2023-03-21","2023-01-26","2024-06-18","2023-11-21","2024-11-26","2024-11-26","2024-04-03","2024-04-03","2023-11-08","2023-11-08","2023-11-08","2024-12-20","2024-01-04","2024-10-04","2024-11-22","2024-03-27","2023-08-15","2023-08-15","2023-08-15","2024-09-19","2023-01-17","2023-07-28","2023-07-28","2023-11-08","2023-11-08","2023-11-08","2023-11-08","2022-12-08","2022-09-12","2022-08-25","2022-08-25","2022-08-23","2022-08-25","2022-07-09","2022-05-10","2022-05-04","2022-04-19","2022-04-07","2022-03-14","2021-10-26","2021-10-13","2021-11-22","2021-11-22","2021-11-24","2021-11-24","2022-01-18","2022-02-02","2022-02-08","2022-02-08","2022-02-08","2022-02-08","2022-01-18","2022-01-18"],"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":[["","","ALLOPURINOL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","MESALAMINE DR","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CICLOPIROX","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","TAVABOROLE","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","JUBLIA","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","DIFLUPREDNATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","DUREZOL","","","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":""}]}]}