{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Malcolm Morrill","gend":0,"currentgend":"","add":"10 MEDOMAK VALLEY EST","city":"WALDOBORO","state":"ME","zip":"04572","dob":"1955-05-18","age":"","mstatus":"","insh":"10000071880","cliId":"","pno":2075423106,"cno":"","email":"pswiley@roadrunner.com","ename":"","eno":"","pphy":"SHERWOOD, LISA L","ppno":2073015800,"pcpadd":"Pen Bay Internal Medicine,4 Glen Cove Dr Ste 202","pcpcity":"Rockport","pcpstate":"ME","pcpzip":"04856","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"10 MEDOMAK VALLEY EST","madd2":"","madd3":"","mcity":"WALDOBORO","mstate":"ME","mzip":"04572","pcpfaxno":2073015332,"pcpnpi":1861619637,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1R91PF1PH14","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1122","R9439","Z743","L03116","B356","G3109","I5022","N184","G319","E1142","R197","R079","Z951","Z09","I480","M7989","S0990XA","I951","I4891","Z7901","I080","N1831","Z794","N1832","I209","I491","I4710","I499","H53461","E11319","H2513","I10","N250","D631","I493","Z043"],"date":["2025-10-23","2025-02-17","2025-02-17","2025-07-22","2025-07-17","2025-07-15","2025-02-21","2025-11-13","2025-07-15","2025-01-20","2025-11-06","2025-02-14","2025-02-14","2025-06-10","2025-07-10","2025-07-22","2025-06-03","2025-06-03","2025-06-03","2025-06-03","2025-02-14","2025-08-15","2025-08-15","2025-07-11","2025-02-17","2025-07-14","2025-07-14","2025-06-05","2025-02-28","2025-02-28","2025-02-28","2025-02-20","2025-02-20","2025-02-20","2025-02-17","2025-06-03"],"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":[["","","ELIQUIS","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","PAROXETINE HCL","","","Select","Select",""],["","","LOPERAMIDE","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","NOVOLOG","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","SACUBITRIL-VALSARTAN","","","Select","Select",""],["","","COLESTIPOL HCL","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":[]}]},{"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":""}]}]}