{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert D Dalzell","gend":0,"currentgend":"","add":"22 WOODVILLE RD","city":"FALMOUTH","state":"ME","zip":"04105","dob":"1955-05-04","age":"","mstatus":"","insh":"10000077471","cliId":"","pno":2077812589,"cno":"","email":"robsterville@gmail.com","ename":"","eno":"","pphy":"KING, KARYN R","ppno":2078741489,"pcpadd":"InterMed,100 Foden Rd Ste 203","pcpcity":"South Portland","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"22 WOODVILLE RD","madd2":"","madd3":"","mcity":"FALMOUTH","mstate":"ME","mzip":"04105","pcpfaxno":2075238590,"pcpnpi":1952890485,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7J50EK5XK02","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z5111","C099","C109","K5903","I10","G893","Z1211","C090","R590","R7303","D649","H35722","Z8589","Z23","R112","T451X5A","Z0000","Z8546","Z7982","K121","R6889","Z923","K1379","H31002","Z0101","K1231","L570","L578","L814","L821","Z85828","K143","K117","Y842","J069","R1310","C770","A691","R221","Z9221","K627","Z85819","Z125","R21","C61","A0471","K1233","B370","R918","A0472","R4182","J029","B002","J020","H31012","Z85818","R1312","K529","Z135","K130","C760","J358","A409","J0430","Z87891","R634","F411","R070","Z08","E876","Z510","R0602","J0431","J90","R509","Z136","R7301","B372","M9901","M542","M9902","M546"],"date":["2023-04-24","2023-07-24","2025-06-30","2023-05-08","2025-10-14","2023-06-02","2025-07-28","2023-09-15","2023-06-12","2025-10-14","2024-06-28","2025-08-28","2025-06-25","2025-10-17","2023-08-08","2023-04-18","2025-10-17","2023-09-29","2023-02-03","2023-08-03","2023-08-03","2025-06-25","2023-07-12","2023-02-27","2025-04-18","2023-04-03","2025-11-06","2025-11-06","2025-11-06","2025-11-06","2025-11-06","2023-07-17","2025-06-25","2023-07-17","2023-11-30","2024-01-05","2023-03-02","2023-06-12","2024-01-08","2025-06-25","2025-07-28","2025-06-30","2025-10-14","2024-10-17","2024-12-09","2023-09-11","2023-06-16","2023-06-02","2023-08-07","2023-09-11","2023-02-03","2024-01-04","2024-02-07","2024-02-07","2024-04-09","2024-12-09","2024-02-07","2023-08-08","2024-03-08","2024-01-19","2023-06-12","2023-06-12","2024-01-05","2024-01-19","2024-01-05","2024-12-09","2023-04-24","2024-01-19","2023-12-21","2024-03-08","2023-04-03","2024-01-08","2024-01-08","2024-01-07","2024-01-04","2022-10-11","2022-09-20","2022-09-21","2022-05-26","2022-05-26","2022-05-26","2022-05-26"],"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":[["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","POKONZA","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","LINEZOLID","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","BACITRACIN","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","SILVER SULFADIAZINE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FENTANYL","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","MOVANTIK","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","DIFICID","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","LACTULOSE","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","VANCOMYCIN HCL","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","OLMESARTAN-AMLODIPINE-HCTZ","","","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":[]}},{"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":""}]}]}