{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jeffrey S Putnam","gend":0,"currentgend":"","add":"37 DIAMOND AVE","city":"GREAT DIAMOND ISLAND","state":"ME","zip":"04109","dob":"1952-12-17","age":"","mstatus":"","insh":"10000080066","cliId":"","pno":2079398997,"cno":"","email":"Jsputnam59@gmail.com","ename":"","eno":"","pphy":"AIKEN, DOUGLAS","ppno":2078469013,"pcpadd":"Intermed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 553","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04112","pcpfaxno":2078741483,"pcpnpi":1093774119,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9A16N85YD62","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K3580","Z23","Z0000","R059","R55","Z125","E7800","M8580","Z0101","H2513","H3589","H02833","R7301","K380","N200","K5649","Z03818","J069","Z20828","S199XXA","S0990XA","G40109","F418","G4719","G629","R053","R051","J301","J0190","S3991XA","S3993XA","D485","L570","K382","R7303","R351","K37","H3562","H35032","R1030","R112","G40909","F325","I10","N529","I4510","R9431","F32A","M25562","M79652","S0181XA","W19XXXA","S0510XA","I081","M8588","R9720","K111","J9801","J0100"],"date":["2025-09-29","2024-06-11","2025-06-17","2023-06-13","2025-01-02","2023-05-30","2025-06-10","2025-06-10","2025-06-10","2025-06-10","2024-06-04","2024-06-04","2024-06-04","2025-09-29","2025-09-29","2025-09-29","2025-11-06","2025-11-06","2024-03-27","2024-08-22","2024-08-22","2025-07-15","2025-07-15","2025-07-15","2025-07-15","2023-07-03","2023-05-17","2023-05-17","2023-05-17","2024-08-22","2024-08-22","2025-10-17","2025-10-17","2025-09-29","2025-06-10","2025-06-10","2025-09-29","2025-07-14","2025-06-10","2025-09-29","2025-09-29","2023-06-06","2023-06-06","2023-06-06","2023-06-06","2025-09-29","2025-09-29","2022-10-03","2022-07-15","2022-07-15","2022-05-25","2022-05-25","2022-05-25","2022-05-26","2022-05-24","2022-05-11","2022-05-06","2022-04-28","2022-03-21"],"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":[["","","CITALOPRAM HBR","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","OXCARBAZEPINE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AMOXICILLIN","","","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":""}]}]}