{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"George E Shores","gend":0,"currentgend":"","add":"189 ALBION RD","city":"Benton","state":"ME","zip":"04901","dob":"1952-08-29","age":"","mstatus":"","insh":"10000082165","cliId":"","pno":2074532519,"cno":"","email":"declined@091422.com","ename":"","eno":"","pphy":"PRESTON, DAVID G","ppno":2078731098,"pcpadd":"Mid Maine Medicine,325B Kennedy Memorial Dr","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"THAYER INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"189 ALBION RD","madd2":"","madd3":"","mcity":"Benton","mstate":"ME","mzip":"04901","pcpfaxno":2078735461,"pcpnpi":1871559203,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4FA8G58GU54","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","R9720","Z8042","M1612","E6601","Z96642","M3130","M25571","R262","Z6843","G4730","I10","G4733","F419","K219","M1712","M25552","M79672","E669","M21171","M154","M25371","M542","M9901","M5450","M9903","Z471","D84821","M3131","L7632","Z9884","R6889","M160","M150","Z79899","M48061","Z713","Z01810","Z87891","I493","R9431","M170","M5416","Z23","R1310","M47816","M5135","M5136","E88819","E559","Z01818","L03115","Z903","M1611","M25751","M19072","M25512","R051","M9953","R0609","Z0100","L089","L03116","E119","M353","R739","Z5181","K449","F17200","M25471","M19071","K2080","M5031","M47812","M4802","M549","E538"],"date":["2024-12-19","2025-07-23","2025-07-23","2024-09-10","2023-11-13","2025-09-16","2025-05-19","2024-11-12","2024-11-22","2023-04-25","2024-08-27","2024-05-23","2025-10-06","2024-08-27","2024-08-27","2025-10-27","2024-04-10","2023-04-12","2024-05-23","2025-02-19","2025-02-19","2025-02-19","2023-04-13","2023-04-13","2023-04-13","2023-04-13","2024-10-07","2023-04-26","2023-04-26","2023-04-26","2023-06-05","2023-10-19","2024-03-01","2025-05-19","2025-05-19","2023-07-10","2022-12-20","2024-07-12","2024-12-19","2024-07-12","2024-07-12","2023-11-08","2022-11-30","2022-11-30","2023-01-03","2022-12-18","2022-12-18","2022-12-18","2023-11-13","2024-05-23","2024-08-02","2024-09-25","2023-05-11","2025-09-16","2025-09-16","2025-10-27","2024-05-10","2024-05-10","2023-10-04","2023-02-28","2024-05-21","2025-10-27","2025-10-27","2023-11-08","2022-12-20","2022-12-20","2024-01-05","2023-01-03","2023-02-28","2025-01-22","2025-01-22","2022-11-01","2022-10-13","2022-10-13","2022-10-13","2022-10-13","2022-08-30"],"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":[["","","METHOTREXATE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","TERBINAFINE HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","METFORMIN HCL ER","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}