{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Craig R Burgess","gend":0,"currentgend":"","add":"25 WEBBER HILL RD","city":"KENNEBUNK","state":"ME","zip":"04043","dob":"1954-05-26","age":"","mstatus":"","insh":"10000080560","cliId":"","pno":2072297314,"cno":2072298217,"email":"surehand@roadrunner.com","ename":"","eno":"","pphy":"MOREAU, SHANNON N","ppno":2072831441,"pcpadd":"Martins Point Health Care,61 Barra Rd","pcpcity":"Biddeford","pcpstate":"ME","pcpzip":"04005","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"25 WEBBER HILL RD","madd2":"","madd3":"","mcity":"KENNEBUNK","mstate":"ME","mzip":"04043","pcpfaxno":2075231136,"pcpnpi":1629337902,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2QP1K94PM20","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":["M6281","C61","C20","S32050S","Z5111","Z85048","Z98890","Z9221","K5730","Z1211","R4182","Z8505","Z136","Z13220","C787","H16142","H0289","Z8546","Z85068","K769","R911","R6889","D696","G893","N6325","D6959","J449","F17200","K219","C189","Z08","Z923","Z716","F0631","J432","D701","K5900","C229","Z0001","L723","H9193","Z452","M810","R220","D122","D124","K5790","C801","K621","C7982","L720","K627","K4090","C19","K635","D128","F419","M5127","M47817","C799","S32050A","Z23","Z0100","M818","S40812A","W19XXXA","L729"],"date":["2025-03-12","2025-11-11","2025-11-11","2025-03-12","2024-08-26","2025-09-22","2023-08-04","2023-08-04","2025-01-10","2025-01-10","2023-11-09","2024-02-07","2024-02-26","2024-02-26","2025-11-11","2025-05-08","2025-05-02","2025-01-13","2023-08-21","2023-08-21","2023-08-21","2023-02-03","2024-09-11","2023-05-24","2024-11-27","2024-09-25","2025-09-22","2024-01-16","2025-09-22","2025-10-16","2024-03-15","2024-03-15","2023-08-16","2024-02-23","2025-11-06","2024-09-11","2024-06-11","2024-01-16","2023-01-05","2023-01-05","2023-01-05","2024-03-01","2024-11-05","2023-03-09","2025-01-10","2025-01-10","2025-01-10","2023-09-28","2025-09-22","2023-12-13","2023-03-09","2025-09-22","2023-01-25","2023-11-09","2025-01-10","2025-09-22","2025-09-22","2024-07-09","2024-07-09","2023-11-09","2024-08-06","2025-03-04","2025-06-05","2025-09-08","2025-05-08","2025-05-08","2023-02-08"],"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":[["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","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":""}]}]}