{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Andrew J Golub","gend":0,"currentgend":"","add":"ONE GARDNERS WAY","city":"KENNEBUNK","state":"ME","zip":"04043","dob":"1950-03-28","age":"","mstatus":"","insh":"10000076974","cliId":"","pno":2079854321,"cno":2074685130,"email":"agolub@une.edu","ename":"","eno":"","pphy":"MICHAUD, KATHRYN","ppno":2077998596,"pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"ONE GARDNERS WAY","madd2":"","madd3":"","mcity":"KENNEBUNK","mstate":"ME","mzip":"04043","pcpfaxno":2077991730,"pcpnpi":1104353838,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7TR7TX5CG66","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23","C44612","L814","L905","M25562","N1830","M1712","J4550","M9907","M9908","M9900","M9901","E119","M4722","J4540","M25511","M25572","R059","L570","R0789","R079","M9903","M9904","M9906","Z0101","H524","H26491","R262","D485","Z85828","I10","H52223","N2581","J4520","Z8042","Z125","R6889","M25579","M25571","N528","M25472","M109","M7989","M25552","M5030","M47812","R0609","R0602","M9902","Z1211","M25471","D72829","E875","D729","M4802","S79912A","S8992XA","M722","N1832"],"date":["2025-11-06","2024-03-07","2024-06-11","2023-12-06","2024-08-05","2025-02-06","2024-08-05","2025-11-12","2024-02-19","2025-11-07","2025-11-07","2025-11-07","2025-11-03","2024-02-03","2024-01-17","2024-01-11","2024-11-26","2025-02-25","2024-12-09","2023-12-29","2023-11-29","2023-03-31","2023-03-31","2024-04-29","2025-01-09","2025-01-09","2023-01-05","2023-02-24","2024-06-11","2024-06-11","2025-04-28","2024-01-09","2024-10-17","2024-04-01","2025-04-28","2025-04-28","2023-03-21","2024-09-12","2024-09-12","2025-11-03","2024-11-26","2024-11-26","2024-11-26","2024-05-14","2024-05-22","2024-05-22","2023-12-29","2023-12-29","2025-11-07","2023-06-08","2024-10-17","2024-09-20","2025-01-20","2024-05-29","2024-05-22","2024-05-14","2024-05-14","2022-11-15","2022-10-13"],"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":[["","","RYBELSUS","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","BUDESONIDE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","MOMETASONE FUROATE","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","PULMICORT FLEXHALER","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","SEREVENT DISKUS","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y 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":{"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":{"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":""}]}]}