{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Daniel L Giguere","gend":0,"currentgend":"","add":"76 CRYSTAL SPRING LN","city":"Rome","state":"ME","zip":"04963","dob":"1954-03-08","age":"","mstatus":"","insh":"10000070240","cliId":"","pno":2072994524,"cno":"","email":"pdgig@msn.com","ename":"","eno":"","pphy":"BROWN, JASON","ppno":2076218800,"pcpadd":"Augusta Family Medicine,15 Enterprise Dr","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"AUGUSTA FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"76 CRYSTAL SPRING LN","madd2":"","madd3":"","mcity":"Rome","mstate":"ME","mzip":"04963","pcpfaxno":2076218801,"pcpnpi":1740592658,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8VG5MA3GT80","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z5112","Z1211","Z510","C3412","C771","Z1159","R590","N281","K7689","I2510","C3490","Z98890","R222","C3432","Z79899","R918","M4856XA","S32040A","Z0000","R946","Z08","Z79633","Z0001","D125","Z87891","Z23","I10","R9720","C779","I959","W11XXXA","H2511","H401132","Z5111","R059","J984","J9811","S32040S","M5440","Z86010","Z961","M5450","C3492","R519","J90","K769","M25561","E785","M549","S299XXA","C3431","S32019D","N289","D649","Z1732","Z9221","Z923","Z0389","Z0100","M85859","Z13820","S32018A","E7800","M25559","C44719","M9900","M9905","M9904","M9908"],"date":["2025-11-10","2024-06-21","2025-03-11","2025-09-29","2025-09-29","2025-01-24","2025-03-19","2025-07-03","2025-03-19","2025-07-03","2025-08-04","2024-12-11","2024-12-11","2025-11-10","2025-11-10","2025-10-02","2024-11-20","2024-11-01","2025-08-28","2025-11-10","2025-10-02","2025-03-05","2024-08-02","2024-06-21","2025-03-05","2024-08-02","2025-05-27","2024-10-02","2025-06-09","2025-06-09","2024-11-01","2024-08-01","2024-08-01","2025-03-05","2025-08-04","2025-10-02","2025-10-02","2024-12-04","2024-12-04","2024-06-21","2024-02-01","2024-10-16","2025-03-19","2025-05-27","2025-07-03","2025-07-03","2023-06-30","2025-08-25","2024-10-16","2024-12-05","2024-12-05","2024-12-05","2024-12-05","2025-03-05","2025-03-05","2025-10-13","2025-10-13","2024-12-26","2025-10-17","2024-11-07","2024-11-07","2024-11-20","2022-11-11","2022-10-18","2022-09-26","2022-08-19","2022-08-19","2022-08-19","2022-08-19"],"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":[["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","ENALAPRIL MALEATE","","","Select","Select",""],["","","DORZOLAMIDE HCL","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","BRIMONIDINE TARTRATE","","","Select","Select",""],["","","DORZOLAMIDE-TIMOLOL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CALCITONIN-SALMON","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","COMBIGAN","","","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":""}]}]}