{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Everett M Merchant","gend":0,"currentgend":"","add":"17 MADAWASKA RD","city":"CARIBOU","state":"ME","zip":"04736","dob":"1954-11-08","age":"","mstatus":"","insh":"10000076955","cliId":"","pno":2074982180,"cno":"","email":"","ename":"","eno":"","pphy":"SWANBERG, CALEB","ppno":"","pcpadd":"Pines Health Services,74 Access Highway","pcpcity":"Caribou","pcpstate":"ME","pcpzip":"04736","pcpcounty":"","pcpid":"","pcpname":"PINES CARIBOU HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"17 MADAWASKA RD","madd2":"","madd3":"","mcity":"CARIBOU","mstate":"ME","mzip":"04736","pcpfaxno":2074926260,"pcpnpi":1013396548,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3VG2T56FW81","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1712","M5450","S93401A","W1840XA","M79671","M5442","M4316","M2578","M5136","M519","Z01818","M5417","M170","Z471","Z96652","M79672","G8929","G629","M47816","M48061","M5416","M5440","I10","Z79899","Z87891","Z1152","M2559","M47814","R6889","Z20822","B349","M13862","M9903","S335XXA","M9905","M9904","M109","M25571","R21","W1830XA","R233","R2242","Z1211","Z1212","H40023","G894","H25813","Z0000","H40003","H2513","M21161","Z96641","Z0101","H524","H52223","H5203","H52222","E860","R059"],"date":["2024-09-12","2023-04-21","2024-06-26","2024-06-22","2023-03-21","2023-07-31","2023-07-31","2023-07-31","2023-09-11","2023-02-28","2024-01-09","2024-11-01","2024-01-26","2025-07-10","2025-07-10","2023-02-28","2023-02-28","2024-11-01","2023-02-28","2023-02-28","2023-11-21","2023-09-28","2024-01-19","2023-07-30","2024-11-01","2023-02-02","2024-02-28","2024-09-20","2023-09-05","2023-02-02","2023-01-27","2024-03-27","2023-08-07","2023-08-07","2023-08-07","2023-08-07","2024-01-27","2024-06-25","2024-06-07","2024-06-22","2024-05-16","2024-05-16","2022-10-24","2022-10-24","2024-09-24","2023-12-06","2024-09-24","2024-02-05","2023-08-29","2023-09-05","2024-01-26","2024-01-26","2024-09-26","2024-09-26","2023-09-05","2024-09-26","2024-09-26","2023-01-27","2023-01-27"],"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":[["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","VALSARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","AMLODIPINE-VALSARTAN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","INDOMETHACIN","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","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":{"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":[]}},{"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":""}]}]}