{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Paul F Tully","gend":0,"currentgend":"","add":"36 MAXWELL WOODS DR","city":"CAPE ELIZABETH","state":"ME","zip":"04107","dob":"1947-03-29","age":"","mstatus":"","insh":"10000081680","cliId":"","pno":2073293314,"cno":"","email":"ptully@maine.rr.com","ename":"","eno":"","pphy":"FRASER, ROBERT J","ppno":2077745816,"pcpadd":"100 FODEN RD. W,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41066143","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"36 MAXWELL WOODS DR","madd2":"","madd3":"","mcity":"CAPE ELIZABETH","mstate":"ME","mzip":"04107","pcpfaxno":2078741483,"pcpnpi":1134206352,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2DH2MH8NP96","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R6889","Z1211","D122","D125","K5730","G5603","G5601","I340","I10","E7800","I222","I2510","M19042","M19041","Z0101","Z0001","Z23","M151","R4701","G459","I083","M8580","Z125","E039","J0140","R4182","Z8673","R4781","R197","L570","R519","R21","L821","L814","R079","I493","I491","I6782","R29818","R9401","Z87898","K219","L309","Z85828","R569","H04123","H18822","I25110","H16142","G44209","I4891","M19049","Z0389","H903","M76892","D225","Z13820","M8588","M1711","E785","D489","I871","R9720","J0190","Z03818","D492","D0421","C4492","C44329","C4442","L578","D044","C44320","R059","M542","J310"],"date":["2023-04-29","2025-11-04","2025-11-04","2025-11-04","2025-11-04","2025-07-28","2025-07-23","2022-12-05","2025-04-28","2025-04-28","2022-12-05","2025-01-08","2025-07-28","2025-07-28","2025-04-25","2025-04-28","2025-04-28","2025-04-28","2024-12-05","2024-12-21","2025-10-06","2023-05-17","2025-04-28","2025-04-28","2023-01-03","2024-12-09","2025-08-11","2024-12-09","2023-12-09","2025-06-09","2024-12-05","2024-11-25","2024-11-25","2024-11-25","2023-10-24","2023-10-24","2023-10-24","2024-12-21","2025-01-17","2025-01-17","2023-10-31","2023-10-31","2025-07-08","2025-07-08","2025-01-10","2025-05-20","2023-11-17","2023-11-20","2023-11-22","2025-08-11","2024-09-29","2025-04-28","2024-09-26","2025-04-30","2023-10-30","2023-05-17","2023-05-17","2023-05-17","2023-10-30","2023-10-24","2025-06-09","2022-12-19","2022-04-29","2022-04-26","2022-04-26","2021-10-25","2021-10-25","2021-10-25","2021-11-22","2021-11-22","2021-11-22","2022-01-03","2022-01-03","2022-01-07","2022-01-26","2022-01-26"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","TOBRAMYCIN-DEXAMETHASONE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","OLMESARTAN MEDOXOMIL","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","TACROLIMUS","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","METHOCARBAMOL","","","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":""}]}]}