{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michael H Brown","gend":0,"currentgend":"","add":"15 MARIE ST","city":"GRAY","state":"ME","zip":"04039","dob":"1955-10-21","age":"","mstatus":"","insh":"10000078041","cliId":"","pno":2076539289,"cno":2076530650,"email":"","ename":"","eno":"","pphy":"FRASER, ROBERT J","ppno":2077745816,"pcpadd":"100 FODEN RD. W,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41066143","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"15 MARIE ST","madd2":"","madd3":"","mcity":"GRAY","mstate":"ME","mzip":"04039","pcpfaxno":2078741483,"pcpnpi":1134206352,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1EV0GM7HX13","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F419","D500","I6523","I739","R5383","I5022","I5023","E119","I2510","Z136","I509","I5042","I10","I255","M5450","Z0000","F17290","K219","R070","E8352","D509","I70211","I708","Z87891","Z01818","R918","J449","J181","I5021","N19","F411","R0602","I420","J9601","I25110","E1151","I214","M5417","M4807","Z98890","M7581","I440","R9439","D649","D519","L853","R7309","R1310","R12","K625","Z125","I5043","N179","I70221","I70222","E785","I70223","I743","I517","E1165","T82858A","M75111","I082","T82855A","I2720","I358","I5189","I519","I70213","I771","R072","I700","J441","R053","D170","Z955","Z23","J439","R21","E1159","M25511","I081","R739","I422","D487","D485","I8003","Z95828","K551","I701","L570","D179","I3481","M7918","L659","M1612","R7989","R220","R221","R0600","M7910","E559","R0789","R3589","K7581"],"date":["2025-08-13","2025-02-21","2025-05-27","2025-11-11","2025-06-19","2025-06-04","2025-10-06","2024-04-25","2025-05-19","2025-04-07","2023-03-27","2024-08-22","2024-01-22","2024-01-22","2023-09-24","2025-02-21","2023-03-16","2025-08-13","2023-02-08","2025-10-08","2025-08-08","2025-08-13","2025-08-13","2025-08-13","2025-10-31","2023-03-15","2025-08-13","2023-03-17","2023-03-24","2023-03-26","2024-06-27","2024-05-22","2023-03-21","2023-03-27","2023-03-27","2024-05-17","2023-03-27","2023-09-28","2023-09-28","2024-05-27","2023-11-16","2024-05-28","2024-05-28","2025-09-29","2025-07-10","2025-11-11","2025-11-11","2025-09-29","2025-09-29","2025-09-29","2025-02-21","2023-03-27","2023-03-27","2024-05-17","2024-05-17","2024-05-17","2024-05-17","2024-05-17","2024-05-24","2024-01-09","2024-06-07","2024-04-23","2023-03-16","2023-03-17","2023-03-17","2024-04-17","2025-06-04","2024-04-17","2024-04-22","2025-05-27","2023-03-09","2025-07-15","2024-05-22","2025-11-11","2022-12-20","2023-05-09","2023-10-20","2024-08-22","2023-06-21","2023-06-21","2023-06-21","2023-06-27","2023-06-12","2023-06-27","2023-09-12","2023-09-12","2025-10-31","2024-09-03","2025-07-15","2025-07-15","2023-09-12","2023-09-12","2025-06-04","2022-09-28","2022-09-28","2022-09-28","2022-05-16","2022-05-16","2022-05-16","2022-05-10","2022-04-12","2022-03-03","2021-12-01","2021-12-01","2021-12-01"],"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":[["","","TORSEMIDE","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","UNIFINE PENTIPS PLUS","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","LANSOPRAZOLE","","","Select","Select",""],["","","VALSARTAN","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","METOLAZONE","","","Select","Select",""],["","","CILOSTAZOL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-100","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","BEVESPI AEROSPHERE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","UNIFINE PENTIPS","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}