{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Thomas J Killeen","gend":0,"currentgend":"","add":"46 WOODLAND HILLS","city":"SOUTH BERWICK","state":"ME","zip":"03908","dob":"1955-05-07","age":"","mstatus":"","insh":"10000076526","cliId":"","pno":2077524102,"cno":"","email":"THOMAS.KILLEEN@ICLOUD.COM","ename":"","eno":"","pphy":"GAUTHIER, MICHAEL N","ppno":2073638430,"pcpadd":"York Family Practice,127 Long Sands Rd Ste 11","pcpcity":"York","pcpstate":"ME","pcpzip":"03909","pcpcounty":"","pcpid":"","pcpname":"YORK FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"46 WOODLAND HILLS","madd2":"","madd3":"","mcity":"SOUTH BERWICK","mstate":"ME","mzip":"03908","pcpfaxno":2073513006,"pcpnpi":1154384485,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5NK4EK2TU72","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","R220","E119","L570","D225","L821","L814","Z08","H25813","H53022","D485","Z0000","D170","E7800","D0421","D23122","C4442","Z7189","Z4800","D492","C44329","S0502XA","H16213","L578","L304","C44229","I872","H903","C44222","L03313","Z85828","Z23","I10","H02423","H2513","L739"],"date":["2025-10-19","2024-12-17","2024-11-27","2025-07-14","2025-01-08","2025-01-08","2025-01-08","2025-01-08","2025-03-03","2025-03-03","2025-07-14","2024-11-25","2025-01-27","2023-09-07","2025-07-14","2023-02-27","2025-07-08","2025-06-11","2025-09-26","2024-05-08","2024-05-08","2024-02-01","2024-02-01","2024-03-19","2023-06-07","2024-03-19","2025-04-29","2024-03-11","2025-08-07","2025-09-23","2022-11-08","2022-10-20","2022-09-02","2022-06-03","2022-06-03","2022-05-09"],"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":[["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","ADVAIR HFA","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","NIFEDIPINE ER","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","MOMETASONE FUROATE","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL HFA","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":{"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":""}]}]}