{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Thomas A Applebee","gend":0,"currentgend":"","add":"160 KELLEY RD","city":"GLENBURN","state":"ME","zip":"04401","dob":"1946-11-29","age":"","mstatus":"","insh":"10000072434","cliId":"","pno":2077358483,"cno":"","email":"Sherry.applebee@aol.com","ename":"","eno":"","pphy":"SZYLVIAN, CHADWICK J","ppno":2079073030,"pcpadd":"C\/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT,PO BOX 7291","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42437291","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"160 KELLEY RD","madd2":"","madd3":"","mcity":"GLENBURN","mstate":"ME","mzip":"04401","pcpfaxno":2079073031,"pcpnpi":1205279056,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4XU3GT6EN93","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G40909","R0609","R079","M170","E538","I10","G4733","R251","R413","J439","R0602","R053","S2241XA","Z1211","D120","D122","J069","Z20822","Z4802","R918","Z860100","K640","M1711","S0083XA","S199XXA","I499","M1712","I517","Z0000","J849","E871","M7989","M23322","M2419","M8568","M25562","G20","Z79899","R9401","R6889","M25561","G8929","R059"],"date":["2025-08-13","2024-05-16","2023-02-24","2025-08-12","2025-07-29","2025-08-21","2025-07-14","2023-04-18","2023-04-18","2025-08-30","2025-05-06","2024-12-23","2025-09-03","2025-02-20","2025-02-20","2025-02-20","2022-10-22","2022-10-22","2025-09-12","2025-01-06","2025-02-20","2025-02-20","2025-02-03","2025-09-03","2025-09-03","2025-04-25","2024-09-12","2024-05-16","2024-10-21","2025-05-06","2023-07-11","2024-04-21","2024-05-29","2024-05-29","2024-05-29","2024-05-29","2023-09-25","2023-09-25","2023-09-25","2024-01-22","2024-05-01","2024-05-01","2024-01-22"],"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":[["","","PREDNISONE","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","SPIRIVA RESPIMAT","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","COMBIVENT RESPIMAT","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","PROPRANOLOL HCL ER","","","Select","Select",""],["","","LEVETIRACETAM","","","Select","Select",""],["","","BUMETANIDE","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","OXCARBAZEPINE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","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":""}]}]}