{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jerome Taffet","gend":0,"currentgend":"","add":"128 MCNALLY RD","city":"CLINTON","state":"ME","zip":"04927","dob":"1954-08-26","age":"","mstatus":"","insh":"10000075706","cliId":"","pno":9174352835,"cno":"","email":"jerometaffet@gmail.com","ename":"","eno":"","pphy":"CHELEUITTE, RAMON E","ppno":"","pcpadd":"12 Spruce St Ste 7,","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"128 MCNALLY RD","madd2":"","madd3":"","mcity":"CLINTON","mstate":"ME","mzip":"04927","pcpfaxno":2076219766,"pcpnpi":1114059672,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5NG8JY9NT28","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F331","J449","G894","K529","F314","M79605","I498","I440","I4519","R9431","M5136","R21","R4182","G8929","F319","I10","I2510","R0789","Q798","M76822","Z87891","J309","M5127","M5126","M47817","M7741","R5383","W57XXXA","M19072","R45851","R079","R109","Z743","M48061","J209","R0602","S93492A","M2550","M5450","M5416","E291","R918","R053","R093","M549","Z79899","M40204","R29898","D1803","N281","N400","I719","Z0100","H348112","M25559","S3992XA","F4321","Z515","N1830","R208","N390","K219","J189","M170","B354","M6282","F23","R7989","R55","M7742","M47816","M4316","Z7951","R197","R194","K2970","M25572","N179","F29","Z136","Z0000","Z23","S0990XA","M1711","M25561","M160","M818","M1712","M25562","K90829","E782","S30860A","M79662","R3129","R059","G4700","F3131","F4310"],"date":["2025-11-11","2025-10-20","2024-03-17","2025-09-29","2024-01-22","2023-09-01","2024-01-14","2024-01-14","2024-01-14","2025-09-27","2024-01-26","2025-08-25","2024-01-14","2024-01-17","2025-02-10","2025-06-12","2025-06-12","2023-10-25","2023-02-06","2023-07-06","2025-06-09","2025-06-09","2023-04-18","2023-04-18","2023-04-18","2024-02-26","2025-10-23","2025-10-23","2024-02-26","2023-10-25","2023-10-25","2023-10-25","2023-10-25","2024-05-01","2025-01-27","2025-01-30","2023-07-06","2023-01-31","2023-05-10","2023-06-01","2024-05-17","2023-11-22","2023-01-18","2023-01-18","2023-08-22","2025-05-29","2025-03-04","2024-06-05","2024-09-27","2024-09-27","2022-12-02","2022-12-02","2024-06-04","2024-06-04","2023-02-24","2024-01-29","2023-12-12","2023-12-12","2025-03-13","2023-08-22","2024-01-04","2023-09-22","2023-02-20","2023-02-03","2025-09-02","2024-01-29","2024-01-29","2023-03-29","2025-09-27","2024-02-26","2023-05-10","2023-05-10","2023-11-22","2024-03-21","2022-12-22","2025-09-27","2023-07-06","2024-02-16","2024-01-14","2023-10-23","2023-10-23","2023-10-23","2023-10-25","2023-02-03","2023-02-03","2023-02-03","2023-02-03","2023-02-03","2023-02-03","2025-05-29","2023-01-11","2022-11-01","2022-11-22","2022-11-21","2022-10-03","2022-09-12","2022-09-27","2022-09-27"],"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":[["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","BUPRENORPHINE","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","DIPHENOXYLATE-ATROPINE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FENTANYL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","CREON","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TESTOSTERONE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","CHOLESTYRAMINE","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","VIBERZI","","","Select","Select",""],["","","SODIUM FLUORIDE 5000 PLUS","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","JATENZO","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","BUPRENORPHINE HCL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","OXCARBAZEPINE","","","Select","Select",""],["","","OXTELLAR XR","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","DOXEPIN HCL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","NALOXONE HCL","","","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":""}]}]}