{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Roger E Farrar","gend":0,"currentgend":"","add":"35 BELLAIRE DR","city":"LIVERMORE FALLS","state":"ME","zip":"04254","dob":"1953-11-21","age":"","mstatus":"","insh":"10000078467","cliId":"","pno":2075002182,"cno":"","email":"lorogf4696@gmail.com","ename":"","eno":"","pphy":"DAVIS, MARY E","ppno":2077955700,"pcpadd":"12 HIGH ST,STE 400","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407634","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"35 BELLAIRE DR","madd2":"","madd3":"","mcity":"LIVERMORE FALLS","mstate":"ME","mzip":"04254","pcpfaxno":2077955727,"pcpnpi":1215917919,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2QD5YG8NP82","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I25119","D751","Z951","G4733","Z0100","R400","I2510","G4730","N289","M9905","I358","R079","R0600","R9720","N401","J90","J9811","N529","I4891","Z09","I10","E7800","R918","I501","R6889","I340","E785","Z48812","R0609","N3281","L570","L814","L821","Z872","N200","Z0000","R0789","Z125","R3911","L723","Z01810","R221","Z87442","R12","Z98890","D649","N179","R0602","I3139","N400"],"date":["2024-12-12","2024-10-28","2025-06-02","2025-10-23","2025-08-28","2023-12-20","2025-03-27","2024-06-03","2025-03-13","2025-03-18","2024-12-13","2024-12-12","2024-12-12","2025-11-10","2024-04-12","2024-12-19","2024-12-18","2025-11-10","2024-12-26","2025-10-02","2025-03-27","2025-03-27","2024-12-27","2025-06-06","2023-07-25","2025-06-06","2025-06-02","2024-12-20","2024-10-28","2023-06-27","2025-08-27","2024-08-22","2024-08-22","2024-08-22","2025-03-13","2024-12-02","2024-10-07","2023-08-10","2023-06-27","2024-02-22","2024-12-13","2022-11-28","2025-03-24","2023-06-14","2022-11-28","2025-01-23","2025-01-23","2024-10-07","2024-12-13","2025-06-02"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","IBU","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}