{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David A Maclean","gend":0,"currentgend":"","add":"882 A MAIN ST","city":"WATERBORO","state":"ME","zip":"04087","dob":"1955-01-25","age":"","mstatus":"","insh":"10000073486","cliId":"","pno":2075908924,"cno":"","email":"maclean546@gmail.com","ename":"","eno":"","pphy":"EATON, JEFFREY","ppno":2073849212,"pcpadd":"Great Works Family Practice,57 Portland St","pcpcity":"South Berwick","pcpstate":"ME","pcpzip":"03908","pcpcounty":"","pcpid":"","pcpname":"GREAT WORKS FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"882 A MAIN ST","madd2":"","madd3":"","mcity":"WATERBORO","mstate":"ME","mzip":"04087","pcpfaxno":2073842008,"pcpnpi":1700835436,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2F23HR1WG76","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M19031","Z8546","M1611","L570","G4733","R42","Z87891","C61","M13831","R051","S76011A","G8918","E785","K219","J209","I639","Z0000","J45909","R400","J208","M25552","M19039","N393","N5231","I872","J4521","J309","U071","R600","E669","R6889","M25531","I447","J0190","Z8481","Z8042","Z803","Z860101","D122","D123","L718","L02821","E65","Z20822","Z01818","L821","L814","D225","Z1211","J40","Z510","N401","L308"],"date":["2025-09-18","2025-06-25","2023-12-01","2025-06-09","2025-11-17","2025-05-30","2025-06-12","2024-05-21","2025-06-12","2024-01-03","2023-12-01","2025-06-12","2025-06-12","2025-06-12","2023-12-05","2025-06-02","2025-09-04","2025-09-04","2025-03-17","2025-01-06","2023-01-10","2025-02-17","2023-03-21","2023-03-21","2024-07-23","2024-08-01","2024-06-19","2024-08-23","2023-03-03","2023-04-28","2023-12-29","2024-11-22","2022-12-02","2023-01-05","2024-09-03","2024-09-03","2024-09-03","2025-10-31","2025-10-31","2025-10-31","2023-08-08","2023-08-08","2022-12-09","2022-12-06","2022-12-02","2023-06-21","2023-06-21","2023-06-21","2025-10-31","2022-09-20","2022-09-16","2022-07-06","2022-06-22"],"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":[["","","MECLIZINE HCL","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","DULERA","","","Select","Select",""],["","","BUPROPION HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","CLINDAMYCIN PHOSPHATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","LEVOFLOXACIN","","","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":""}]}]}