{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Stephen E Kudlach","gend":0,"currentgend":"","add":"137 COTTAGE RD","city":"WINDHAM","state":"ME","zip":"04062","dob":"1955-04-10","age":"","mstatus":"","insh":"10000078833","cliId":"","pno":2077760020,"cno":"","email":"bbbssteve@yahoo.com","ename":"","eno":"","pphy":"WADLAND, WILLIAM R","ppno":2078282402,"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":"137 COTTAGE RD","madd2":"","madd3":"","mcity":"WINDHAM","mstate":"ME","mzip":"04062","pcpfaxno":2078287850,"pcpnpi":1154499002,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5H05R89UY98","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":["M48062","Z4789","Z981","G5702","G5701","I739","N1830","M47817","E089","R0600","M5450","M9902","M9903","M9904","I10","N182","E119","I70213","M48061","E785","M4316","E559","Z711","W57XXXA","M4608","R011","M6281","R102","K439","K429","M1612","Z98890","Z8719","M79675","M47816","M19072","M25552","M7062","Z23","M7632","M7918","S73102A","M4726","M5117","E118","M6208","E1042","M5136","M4310","E1122","Z125","N289","M549","M7602","S3219XA","R93421","N2889","M7631","M6530","R200","G5602","G5601","Z87891","Z136","M65332","M79641","E875","R262","M65341","M109","M79642","M65322","M65342","Z20828","R6889"],"date":["2025-11-14","2025-11-14","2025-07-10","2025-01-06","2025-01-06","2025-06-13","2025-03-19","2023-06-28","2023-06-28","2024-03-04","2025-04-23","2024-04-02","2024-04-02","2024-03-08","2025-04-23","2024-06-06","2025-09-18","2025-06-13","2025-07-29","2025-04-23","2025-04-23","2025-03-19","2023-06-29","2023-06-29","2024-06-26","2025-06-02","2023-05-18","2023-02-02","2025-01-08","2025-01-08","2024-09-01","2025-01-31","2025-01-31","2024-08-15","2024-12-10","2025-04-02","2023-08-07","2022-12-07","2024-11-25","2022-12-07","2023-08-07","2024-09-27","2024-12-18","2024-12-18","2024-10-21","2024-10-21","2025-04-02","2023-04-07","2023-04-07","2023-04-07","2025-09-18","2024-06-06","2025-07-10","2022-11-23","2022-11-19","2022-09-14","2022-09-14","2022-07-28","2022-06-09","2022-06-10","2022-06-10","2022-06-10","2022-05-24","2022-05-24","2022-05-05","2022-04-25","2022-04-26","2022-04-21","2022-04-22","2022-04-12","2022-04-15","2022-04-11","2022-04-11","2022-01-14","2022-01-06"],"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":[["","","METFORMIN HCL","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","RYBELSUS","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","ONETOUCH VERIO MID CNTRL SOLN","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","PIOGLITAZONE HCL","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","TRAMADOL HCL","","","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":""}]}]}