{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kevin M Gillis","gend":0,"currentgend":"","add":"3 CANTERBURY WAY","city":"Cape Elizabeth","state":"ME","zip":"04107","dob":"1954-12-29","age":"","mstatus":"","insh":"10000072100","cliId":"","pno":2072729242,"cno":"","email":"","ename":"","eno":"","pphy":"LENA, SEAN R","ppno":2077745816,"pcpadd":"InterMed,84 Marginal Way Ste 800","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"3 CANTERBURY WAY","madd2":"","madd3":"","mcity":"Cape Elizabeth","mstate":"ME","mzip":"04107","pcpfaxno":2078741483,"pcpnpi":1265895502,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8JG8HR7NA44","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J069","R1032","E663","Z0000","I4892","Z8546","M76822","M2142","M2141","M79672","I484","M25572","M6281","M25472","E871","I483","F5221","C61","H2512","H2511","Z13220","R0602","R5383","H33022","L578","L821","D1801","L918","Z0100","Z7901","H33313","M5450","K5901","K5790","N200","R4182","Z23","I459","H2513","J0100","S93492A","H43813","R6889","H43811"],"date":["2025-01-06","2023-03-06","2023-11-21","2025-09-26","2025-01-06","2025-09-26","2023-11-02","2023-05-26","2023-05-26","2023-05-26","2025-04-24","2023-11-02","2023-11-02","2023-11-02","2025-01-07","2025-02-17","2024-05-01","2025-10-09","2023-08-22","2023-08-01","2025-09-26","2024-10-28","2024-10-28","2025-08-27","2024-04-03","2024-04-03","2024-04-03","2024-04-03","2025-02-27","2024-12-17","2025-08-25","2023-03-02","2023-03-02","2023-03-02","2023-03-06","2025-02-17","2024-11-18","2025-04-24","2023-06-05","2023-04-14","2023-07-21","2025-04-28","2023-04-17","2025-01-13"],"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",""],["","","OFLOXACIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","POLYMYXIN B SUL-TRIMETHOPRIM","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","Select","Select",""],["","","HYDROCORTISONE","","","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":""}]}]}