{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Randy D Smart","gend":0,"currentgend":"","add":"388 MEDFORD RD","city":"MILO","state":"ME","zip":"04463","dob":"1951-05-27","age":"","mstatus":"","insh":"10000072337","cliId":"","pno":2074472652,"cno":"","email":"","ename":"","eno":"","pphy":"HAMLIN, JEAN M","ppno":2079437752,"pcpadd":"Milo Family Practice,135 Park St","pcpcity":"Milo","pcpstate":"ME","pcpzip":"04463","pcpcounty":"","pcpid":"","pcpname":"KATAHDIN VALLEY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"388 MEDFORD RD","madd2":"","madd3":"","mcity":"MILO","mstate":"ME","mzip":"04463","pcpfaxno":2079431002,"pcpnpi":1316203300,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9QM0RU0QU13","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N401","J4550","L814","L821","Z08","Z85828","R079","L570","E785","I10","K5909","D3131","H31091","H43813","R9431","R6889","G4731","D638","Z0000","R918","Z8619","R5383","Z1211","Z862","J329","R509","J4540","G4739","T7849XD","D225","D692","J181","J9811","E7849","J449","D649","G4762","Z125","J984","J069","R7303","H3540","J189"],"date":["2025-07-28","2023-05-03","2024-07-23","2024-07-23","2023-07-20","2023-07-20","2022-10-07","2025-07-30","2025-09-10","2025-01-14","2024-02-05","2025-08-13","2025-08-13","2025-08-13","2024-07-17","2023-11-10","2025-09-02","2024-09-26","2025-05-08","2025-04-09","2025-04-09","2024-02-20","2024-05-06","2025-09-10","2024-06-11","2024-06-13","2025-04-09","2025-04-09","2023-03-09","2024-07-23","2024-07-23","2025-04-09","2024-07-24","2023-06-07","2023-03-02","2024-06-20","2025-09-10","2023-04-24","2024-07-15","2024-06-13","2025-05-08","2024-07-30","2024-06-13"],"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":[["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","MODAFINIL","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FLUTICASONE-VILANTEROL","","","Select","Select",""],["","","SCOPOLAMINE","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","SPIRIVA RESPIMAT","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","BREZTRI AEROSPHERE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","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":""}]}]}