{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John D Mayer","gend":0,"currentgend":"","add":"161 A PINE HILL RD","city":"CAPE NEDDICK","state":"ME","zip":"03902","dob":"1941-11-19","age":"","mstatus":"","insh":"10000075433","cliId":"","pno":2073611308,"cno":"","email":"jdmayer87@gmail.com","ename":"","eno":"","pphy":"POLLARD, DOUGLAS C","ppno":2073513530,"pcpadd":"York Hospital Internal Medicine of York,12 Hospital Dr Ste B","pcpcity":"York","pcpstate":"ME","pcpzip":"03909","pcpcounty":"","pcpid":"","pcpname":"YORK HOSPITAL INTERNAL MEDICINE OF YORK","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 1231","madd2":"","madd3":"","mcity":"OGUNQUIT","mstate":"ME","mzip":"03907","pcpfaxno":2073513574,"pcpnpi":1710969803,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4DU0WE2MP45","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S72002D","W010XXD","Y929","D171","R300","S7222XD","R82998","R0789","I509","R310","Z0000","H5789","M9702XD","E559","Z96642","N3289","C678","I4821","H25811","H401131","H25812","H25813","K222","K2090","H16142","H401111","R531","G319","S7222XA","D3131","H16202","R1314","R12","S72002A","W010XXA","M9702XA","L905","A084","R339","J9811","R059","D72829","K8020","R1011","R7989","K760","I6523","I6501","R7301","I10","H401133","C679","Z9841","R319","K8021","N401","Z125","S7292XA","M25552","Z23","W19XXXA","I083","H409","H2511","T7849XA","Z03822","N179","N189","E785"],"date":["2025-02-04","2024-07-19","2024-07-19","2023-08-29","2025-10-23","2024-10-25","2025-10-08","2023-03-20","2024-05-10","2025-10-14","2025-06-06","2023-10-05","2024-07-19","2025-05-30","2024-10-25","2025-11-03","2025-10-27","2025-08-15","2024-04-01","2024-10-01","2024-02-06","2024-02-06","2024-11-12","2024-11-12","2023-12-11","2024-04-01","2024-04-06","2024-04-06","2024-04-06","2023-12-08","2023-12-21","2024-11-12","2024-10-11","2024-04-09","2024-04-09","2024-04-09","2024-04-08","2025-01-03","2025-09-30","2024-04-08","2024-04-08","2024-04-08","2024-04-07","2024-04-07","2024-04-07","2024-04-07","2025-01-30","2024-04-06","2023-11-10","2024-11-21","2025-10-16","2025-11-11","2024-09-11","2025-10-06","2025-10-06","2025-10-14","2025-10-14","2024-04-07","2024-04-07","2024-11-07","2024-04-07","2024-04-07","2024-04-01","2024-04-01","2024-04-01","2024-04-10","2024-04-06","2024-04-19","2022-11-14"],"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":[["","","OMEPRAZOLE","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","ACETAZOLAMIDE ER","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","TOBRAMYCIN-DEXAMETHASONE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","DIFLUPREDNATE","","","Select","Select",""],["","","GEMFIBROZIL","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)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":""}]}]}