{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ricky S Charles","gend":0,"currentgend":"","add":"95 SMOOTH LEDGE RD","city":"STANDISH","state":"ME","zip":"04084","dob":"1955-12-05","age":"","mstatus":"","insh":"10000080078","cliId":"","pno":2076155966,"cno":"","email":"","ename":"","eno":"","pphy":"MCATEER, TIMOTHY B","ppno":2075233900,"pcpadd":"100 GANNETT DRIVE,SUITE C","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"95 SMOOTH LEDGE RD","madd2":"","madd3":"","mcity":"STANDISH","mstate":"ME","mzip":"04084","pcpfaxno":2078741483,"pcpnpi":1619042595,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7P58QU3WR66","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M75111","M25511","F4322","N200","G4733","S46011A","Z0101","S4991XA","S00259A","G5601","M65321","E785","E669","N401","N138","G5602","M65322","Z4789","N3001","K219","N132","N202","N179","N3000","M65341","M654","R109","M65351","K5730","Z0001","N201","R310","N2889","G5603","R911","E119","R7303","Z125","R1011","M75101","F411","K760","E1169","Z6832","R1031","R6889","Z23","Z0000","M66321","G8918","F419","M6530","Z0189","H903","E668","F320","M65352","M25541","M25542","Z932","G4737","Z638","R053","G4730","F325","N390","R319","M546"],"date":["2024-04-01","2024-08-06","2025-08-04","2025-08-12","2025-05-30","2024-02-21","2025-08-11","2024-02-21","2024-02-07","2025-04-18","2025-04-04","2025-11-05","2025-04-18","2025-08-12","2025-08-12","2025-04-18","2025-04-18","2024-08-08","2023-03-10","2023-03-31","2023-03-10","2023-03-10","2023-03-10","2023-03-10","2025-09-25","2025-07-10","2025-06-06","2025-09-25","2025-06-27","2025-10-31","2023-03-31","2023-02-06","2023-02-06","2025-03-20","2023-03-08","2025-08-28","2025-02-04","2024-10-31","2025-06-27","2024-08-08","2025-07-07","2023-03-08","2025-11-05","2025-04-18","2023-03-08","2025-08-11","2025-10-15","2024-10-25","2024-04-01","2024-04-01","2023-11-29","2022-12-28","2024-02-07","2024-08-29","2024-01-02","2025-07-07","2024-02-15","2025-03-20","2025-03-20","2024-04-01","2022-05-31","2022-05-12","2022-04-08","2022-03-15","2022-03-15","2021-11-06","2021-11-06","2022-02-07"],"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":[["","","MOUNJARO","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","CEPHALEXIN","","","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":""}]}]}