{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Thomas S Workman","gend":0,"currentgend":"","add":"2817 RTE 2","city":"Hermon","state":"ME","zip":"04401","dob":"1951-10-26","age":"","mstatus":"","insh":"10000074057","cliId":"","pno":2073562037,"cno":"","email":"tsworkman1951@gmail.com","ename":"","eno":"","pphy":"DUCHENE, JOSHUA J","ppno":2079073777,"pcpadd":"St Joseph Family Medicine,900 Broadway","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"2817 RTE 2","madd2":"","madd3":"","mcity":"Hermon","mstate":"ME","mzip":"04401","pcpfaxno":2079073778,"pcpnpi":1013409432,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8AC1RU4MX80","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4819","M79675","J449","R6889","I5032","I4891","R0609","I441","I4729","G4733","C44519","Z0000","Z23","R0683","N400","E785","N1831","R339","R4182","N393","N3941","N401","R338","N410","N411","R7881","I480","R9431","B957","N390","I4720","I082","I77810","Z1629","H1033","M19011","M25522","T83028A","R350","R799","A419","H903","H9313","I517","E669","Z8619","I483","M25561","M109","I499","R944","Z452","H35351","H35371","H40013","H524","Z85828","Z7951","I440","I493","I498","I081","I253","D225","L821","L814","L570","D485","I38","R7989","N179","E875","I313","A411","N136","Z1611","A000","R0600","N200","N1330"],"date":["2024-09-16","2024-07-09","2023-06-08","2023-05-10","2025-02-14","2025-01-29","2023-09-11","2024-06-26","2023-01-31","2025-08-19","2025-04-30","2025-01-29","2023-11-22","2023-06-15","2024-08-13","2024-07-16","2023-11-27","2024-02-26","2023-02-01","2023-04-19","2023-04-19","2023-02-01","2023-02-01","2023-02-01","2023-02-01","2022-12-22","2023-11-22","2022-10-06","2022-12-20","2022-10-20","2022-10-17","2023-05-11","2023-12-08","2022-11-03","2025-02-08","2025-07-30","2024-03-06","2022-10-27","2023-06-23","2024-05-14","2022-10-06","2025-04-04","2025-04-04","2023-12-08","2023-06-08","2022-10-03","2023-06-08","2022-12-22","2024-06-17","2024-06-17","2024-07-08","2022-10-17","2025-04-18","2025-04-18","2025-04-18","2024-07-18","2022-12-22","2022-12-22","2024-06-26","2024-06-26","2024-06-26","2022-12-22","2022-12-22","2025-04-18","2025-04-18","2025-04-18","2025-04-18","2025-04-18","2022-09-22","2022-09-18","2022-09-22","2022-09-19","2022-09-21","2022-09-22","2022-09-22","2022-09-22","2022-09-27","2022-09-13","2022-09-18","2022-09-18"],"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":[["","","FLUOROURACIL","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","CALCIPOTRIENE","","","Select","Select",""],["","","MITIGARE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","FLUCONAZOLE","","","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":""}]}]}