{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Glenn E Perry","gend":0,"currentgend":"","add":"7 PILLSBURY ST","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1955-08-19","age":"","mstatus":"","insh":"10000077873","cliId":"","pno":2078799463,"cno":"","email":"maryjaneperry@msn.com","ename":"","eno":"","pphy":"DOBIESKI, STEVEN T","ppno":2077745816,"pcpadd":"InterMed,84 Marginal Way Ste 800","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"7 PILLSBURY ST","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":2078741483,"pcpnpi":1942279617,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9VQ7W99VQ43","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R3914","N320","I10","Z0000","C61","E1165","E1169","E1122","Z794","Z23","R338","N35919","R339","R319","Z7982","N3289","I129","N189","R310","Z0001","R1031","I700","K5790","N3090","J0101","J069","D72819","E7800","E785","E669","N3041","C4491","L97521","E1140","E1159","E11621","L97522","L84","Z01818","C679","Z0101","M2062","M2061","E782","E559","M722","M79671","M79672","J984","N99113","Z8631","N99114","Z08","Z8546","Z923","J9811","N99116","N281","K8020","K5730","D123","Z86010","D124","Z800","T83091A","N3040","K5641","E1121","H35373","D649","N35812","N35813","K625","L570","Z85828","L578","L821","R011","I350","T83098A","C44712","N35914","K627","Z510","Z9079","S91109A","M7732","M19072","L03116","N35912","N23","N35913","M7989","R21","F4321","M25551","N393","R151","S91309A","K5900","L989","I739","E13621","D225","D1801","H2511","H2512","Z8042","H259","H35371","H2513","E119","R6889","M5441","G8929","R9720"],"date":["2023-09-22","2024-01-08","2024-12-10","2024-12-10","2025-10-29","2025-10-09","2025-10-09","2025-10-09","2025-10-09","2025-10-09","2025-04-09","2025-04-09","2025-09-17","2025-09-17","2025-09-16","2025-03-23","2025-03-23","2025-03-23","2025-09-17","2025-07-17","2025-04-18","2025-04-18","2025-04-18","2025-04-18","2022-12-29","2022-12-29","2024-06-06","2024-06-06","2025-09-17","2024-08-22","2025-05-09","2024-08-30","2024-06-07","2024-04-28","2024-04-28","2024-07-25","2024-05-16","2024-07-11","2024-02-06","2025-03-23","2025-06-04","2024-06-07","2024-06-07","2025-10-09","2025-10-09","2023-08-14","2023-08-14","2023-08-14","2025-11-12","2023-09-22","2024-07-18","2024-10-30","2025-10-29","2025-10-29","2025-10-29","2025-05-09","2025-04-17","2023-10-02","2023-10-02","2023-10-02","2024-07-17","2024-07-17","2024-07-17","2024-07-17","2025-09-17","2025-11-12","2024-09-27","2024-11-12","2025-06-04","2024-08-22","2024-02-13","2024-02-13","2024-10-09","2025-09-05","2025-09-05","2025-09-05","2025-09-05","2024-10-08","2025-03-17","2025-09-17","2024-08-30","2024-02-13","2025-11-05","2022-11-22","2024-03-07","2024-05-09","2024-05-09","2024-05-09","2024-05-15","2025-06-18","2023-11-11","2023-11-11","2024-05-15","2024-06-10","2023-07-28","2023-07-28","2023-07-28","2023-07-28","2024-02-21","2024-02-21","2024-02-21","2024-09-04","2024-09-04","2022-10-10","2022-10-10","2022-09-13","2022-08-16","2022-08-12","2022-08-16","2022-05-26","2022-05-26","2022-05-26","2022-02-11","2022-04-25","2022-04-25","2022-04-25"],"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":[["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-100","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","DOXAZOSIN MESYLATE","","","Select","Select",""],["","","INSULIN DEGLUDEC PEN (U-100)","","","Select","Select",""],["","","ENALAPRIL MALEATE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","DEXCOM G6 TRANSMITTER","","","Select","Select",""],["","","UNIFINE PENTIPS PLUS","","","Select","Select",""],["","","FREESTYLE LIBRE 2 PLUS SENSOR","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","INSULIN ASPART FLEXPEN","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","NOVOLOG","","","Select","Select",""],["","","DEXCOM G6 SENSOR","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","POLYMYXIN B SUL-TRIMETHOPRIM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","PFIZER 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":[]}},{"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":""}]}]}