{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Franklin D Leclair","gend":0,"currentgend":"","add":"171 MANCHESTER RD","city":"STEEP FALLS","state":"ME","zip":"04085","dob":"1963-10-10","age":"","mstatus":"","insh":"10000070968","cliId":"","pno":2076424337,"cno":"","email":"","ename":"","eno":"","pphy":"FRASER, ROBERT J","ppno":2077745816,"pcpadd":"100 FODEN RD. W,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41066143","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"171 MANCHESTER RD","madd2":"","madd3":"","mcity":"STEEP FALLS","mstate":"ME","mzip":"04085","pcpfaxno":2078741483,"pcpnpi":1134206352,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9W18WV9EQ32","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S52501A","Z23","R748","K7030","M2740","K219","E785","F17200","J341","K766","I10","E782","K7460","K3189","Z125","S52502A","S52602A","S52601A","E538","B351","M79674","L602","M79675","Z0001","S52531A","S52532A","W010XXA","G8918","Z0000","E669","K838","Z86010","F1020","Z860100","S52591A","S52551A","S199XXA","S0990XA","F1010","F3341","K7581","G40909","S0993XA","K7469","F17210","M25561","K745","K30","Z1211","H2513","R7989"],"date":["2025-03-26","2024-10-28","2024-10-28","2024-11-04","2023-07-13","2024-10-28","2023-07-13","2023-07-13","2023-07-13","2024-02-13","2025-04-30","2024-10-28","2024-07-03","2023-11-22","2024-10-28","2025-03-26","2025-03-26","2025-03-26","2023-10-25","2024-12-31","2024-12-31","2024-12-31","2024-12-31","2023-10-25","2025-03-07","2025-03-07","2025-03-07","2025-03-13","2024-10-28","2023-11-22","2022-12-21","2024-05-02","2024-11-04","2024-11-04","2025-03-05","2025-03-13","2025-03-05","2025-03-05","2023-08-01","2025-04-30","2025-04-30","2025-04-30","2025-03-05","2024-11-04","2023-07-13","2022-11-14","2022-10-26","2022-10-12","2022-08-09","2022-06-29","2021-10-29"],"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":[["","","CLONAZEPAM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","CARBAMAZEPINE","","","Select","Select",""],["","","IBU","","","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":""}]}]}