{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donald E Fogg","gend":0,"currentgend":"","add":"963 MAIN ST","city":"BRADLEY","state":"ME","zip":"04411","dob":"1935-01-03","age":"","mstatus":"","insh":"10000080189","cliId":"","pno":2079893088,"cno":"","email":"declined@12222023.com","ename":"","eno":"","pphy":"LANGLEY, AMY A","ppno":"","pcpadd":"PO BOX 1599,","pcpcity":"BANGOR","pcpstate":"ME","pcpzip":"44021599","pcpcounty":"","pcpid":"","pcpname":"BREWER MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"963 MAIN ST","madd2":"","madd3":"","mcity":"BRADLEY","mstate":"ME","mzip":"04411","pcpfaxno":2079470435,"pcpnpi":1083906622,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1AJ5R77MW92","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B351","F418","R058","E1142","I25119","S72001D","Z125","C44319","C4441","L570","D225","L821","L814","Z7189","E8342","S20361A","Z789","R531","W19XXXA","M25551","I10","S72001A","N179","R778","G20","G20B1","R1310","Z471","Z96641","S72011A","Z23","Z01818","J449","S72041A","I2510","W1839XA","W57XXXA","Z98890","I6522","E119","K5909","G20A1","Z87891","Z79899","E785","R7309","R946","E559","Q839","N6489","R55","S7291XD","R109","N281","K5730","K5900","R399","R911","R9431","R928","E1140","N390","Z0000","Z4789","H52223","H524","E113293","I119","I509","D485","L239","I252","L708","Z9181","L820","L84","M2012","R300","R350","M2011","Z08","Z85828","S72091A","Z7982","Z8673","M25559","Z743","R4189"],"date":["2023-07-05","2024-12-02","2025-10-16","2024-09-04","2023-05-15","2023-09-03","2024-09-04","2023-11-21","2023-10-16","2025-11-07","2025-05-23","2025-05-23","2025-05-23","2024-10-16","2023-08-07","2022-12-09","2023-04-21","2023-04-28","2023-04-22","2023-04-21","2024-10-23","2023-06-05","2023-04-24","2023-04-24","2023-04-24","2024-09-10","2025-10-30","2023-06-05","2023-06-08","2023-04-21","2024-10-29","2023-04-21","2024-03-18","2023-04-22","2025-08-12","2023-04-21","2022-12-09","2023-04-13","2023-04-13","2023-04-13","2025-05-20","2025-03-12","2025-03-12","2025-03-12","2025-08-19","2025-08-19","2025-08-19","2025-08-19","2023-06-26","2023-06-26","2023-05-12","2023-05-09","2023-05-12","2023-05-12","2023-05-12","2023-05-12","2023-05-12","2023-05-12","2023-05-12","2023-06-26","2023-08-30","2023-04-27","2025-05-15","2023-04-26","2025-03-20","2025-03-20","2025-03-20","2024-03-18","2023-04-11","2024-10-16","2024-06-06","2023-04-24","2025-05-23","2025-06-05","2024-10-16","2023-08-30","2023-08-30","2023-07-13","2023-07-13","2023-08-30","2023-09-29","2023-09-29","2023-04-21","2023-04-04","2023-04-04","2023-04-24","2023-04-24","2023-12-07"],"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":[["","","CARBIDOPA-LEVODOPA","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}