{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Francis L Bathe","gend":0,"currentgend":"","add":"2 MEADOWOOD DR","city":"SCARBOROUGH","state":"ME","zip":"04074","dob":"1954-09-27","age":"","mstatus":"","insh":"10000070450","cliId":"","pno":2078383861,"cno":"","email":"frankbathe@aol.com","ename":"","eno":"","pphy":"MURRAY PULSIFER, KRISTY A","ppno":2078741489,"pcpadd":"InterMed,100 Foden Rd Ste 203","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":"2 MEADOWOOD DR","madd2":"","madd3":"","mcity":"SCARBOROUGH","mstate":"ME","mzip":"04074","pcpfaxno":2078741483,"pcpnpi":1356310098,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2Y00YM3PT23","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","K7689","R42","M25562","M19011","M25711","R160","Z85820","Z800","M19012","Z125","M4802","M5011","M4722","M4312","Z0101","H35373","Z96611","M1712","Z01818","Z131","M899","Z471","M160","N401","I493","I4710","I4720","Z0000","M25569","M542","M2560","M6281","M62838","I10","F17200","G8918","L570","L578","D1801","R6889","Z8249","E785","G4700","Z23","M48061","M4726","L03313","I6523","Z87891","M23322","L821","H903","Z96652","K769","M25462","M9903","M5432","M5450","M9901","M1711","I088","M5412","M47812","M75111","M25411","N281","L259","Z8349","R454","Z87828","G44319","W19XXXA","Z043","S0990XA","R519","N3943","F411"],"date":["2025-11-14","2025-01-27","2025-11-04","2025-05-01","2025-02-06","2023-08-15","2025-06-03","2025-06-03","2025-06-03","2025-07-29","2025-11-17","2024-07-28","2024-07-28","2024-07-28","2024-07-28","2025-08-04","2025-08-04","2025-07-17","2025-03-13","2025-03-06","2025-03-04","2025-03-04","2025-03-25","2025-02-26","2025-11-17","2024-11-27","2024-11-27","2024-11-27","2024-10-22","2025-02-26","2024-11-05","2024-11-05","2024-11-05","2024-11-05","2025-11-04","2023-08-31","2025-03-13","2022-12-02","2025-02-11","2022-12-02","2023-09-29","2024-12-10","2025-11-04","2023-10-19","2023-10-19","2025-04-23","2025-04-23","2023-10-19","2024-05-30","2025-03-13","2025-01-06","2025-02-11","2025-10-08","2025-06-02","2025-06-03","2025-05-01","2025-06-18","2025-06-18","2025-06-18","2025-06-18","2025-03-13","2024-12-10","2025-02-06","2025-02-06","2023-08-28","2023-08-28","2025-06-03","2024-07-12","2022-11-23","2022-05-09","2022-05-09","2022-03-10","2022-03-10","2022-03-10","2022-03-10","2022-03-10","2021-11-18","2022-02-03"],"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":[["","","PAXLOVID (EUA)","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","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":""}]}]}