{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gary R Littlefield","gend":0,"currentgend":"","add":"15 TOWN FARM RD","city":"WINTERPORT","state":"ME","zip":"04496","dob":"1953-11-12","age":"","mstatus":"","insh":"10000073495","cliId":"","pno":2072234044,"cno":"","email":"garylitt53@gmail.com","ename":"","eno":"","pphy":"MOODY, LAUREN M","ppno":2072230965,"pcpadd":"Winterport Community Health Center,775 N Main St","pcpcity":"Winterport","pcpstate":"ME","pcpzip":"04496","pcpcounty":"","pcpid":"","pcpname":"PENOBSCOT COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"15 TOWN FARM RD","madd2":"","madd3":"","mcity":"WINTERPORT","mstate":"ME","mzip":"04496","pcpfaxno":2072230975,"pcpnpi":1356902605,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7JJ1YC1AX04","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E113291","E113212","R21","E1065","E10319","E6609","Z6831","M792","L309","E103391","E103312","H3092","Z0000","S40861D","E113391","E113312","R6889","D61818","R7989","E103212","Z8042","Z125","Z0101","H40013","D120","D122","D124","Z1211","Z86010","S51819A","W57XXXA","E1140","E785","D649","R3911","E109","E559","E1042","L84","K635","Z6830","Z6832","R351","Z794","Z9641","M2142","M7732","M79672"],"date":["2023-02-13","2023-02-13","2025-05-20","2025-11-19","2024-12-19","2024-07-17","2023-09-20","2025-09-25","2025-06-05","2025-10-03","2024-08-22","2024-08-22","2025-04-25","2025-04-17","2023-09-27","2023-09-27","2023-12-30","2024-06-20","2024-06-20","2025-10-03","2025-04-25","2025-04-25","2025-02-24","2025-09-16","2023-01-09","2023-01-09","2023-01-09","2023-01-09","2023-01-09","2025-04-08","2025-04-08","2025-01-23","2025-01-23","2023-01-13","2023-12-08","2023-12-08","2023-12-08","2024-05-16","2024-05-16","2023-01-09","2023-03-13","2024-07-17","2022-09-12","2022-09-12","2022-09-12","2022-09-14","2022-06-14","2022-06-14"],"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":[["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","CONTOUR NEXT TEST STRIP","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","ACCU-CHEK GUIDE TEST STRIP","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CREON","","","Select","Select",""],["","","BAQSIMI","","","Select","Select",""],["","","NOVOLOG","","","Select","Select",""],["","","INSULIN ASPART","","","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":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}