{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lucien E Lafontaine","gend":0,"currentgend":"","add":"17 FOX RUN RD","city":"GRAY","state":"ME","zip":"04039","dob":"1951-11-23","age":"","mstatus":"","insh":"10000082793","cliId":"","pno":2072121465,"cno":"","email":"fivespeedpony@gmail.com","ename":"","eno":"","pphy":"EMERSON, FRED E","ppno":2078923233,"pcpadd":"301C US ROUTE 1,","pcpcity":"SCARBOROUGH","pcpstate":"ME","pcpzip":"40749701","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE AND PED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"17 FOX RUN RD","madd2":"","madd3":"","mcity":"GRAY","mstate":"ME","mzip":"04039","pcpfaxno":2078930752,"pcpnpi":1487722278,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3U55C73EG89","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1712","M1711","Z96651","Z0001","D3132","M170","Z471","Z85820","K642","L2489","K594","K6289","Z96652","Z85038","E782","Z01818","M19071","Z4789","G8918","E119","Z0000","E6601","Z6835","I10","R739","I8392","M79671","M21161","Z1211","K635","Z09","A000","K641","E113293","K644","K645","K625","M25461","D229","L821","M21162","Z125","E669","R6889","E785","K219","Z96659","B351","M25562","G8929","R7303","H35033","D225","D485","L570"],"date":["2024-12-27","2025-03-21","2025-03-21","2025-09-19","2024-10-21","2024-10-02","2025-03-25","2024-12-09","2024-03-12","2024-03-12","2024-03-12","2024-03-12","2024-12-27","2025-09-18","2025-09-18","2025-01-03","2023-12-11","2024-12-27","2025-01-30","2025-09-18","2024-07-08","2023-09-01","2023-09-01","2025-01-30","2023-05-11","2024-12-09","2023-12-11","2025-01-30","2024-08-06","2024-08-06","2023-06-08","2025-02-03","2023-12-13","2025-09-19","2023-12-13","2023-12-13","2023-12-13","2025-02-14","2024-12-09","2024-12-09","2024-03-08","2025-09-18","2024-01-02","2023-09-06","2024-10-31","2024-10-31","2025-02-14","2022-12-01","2024-01-29","2024-01-29","2022-11-02","2022-08-22","2022-05-18","2022-05-18","2022-05-18"],"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":[["","","CELECOXIB","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","GAVILYTE-C","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUGMENTED","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","IBU","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","SIMVASTATIN","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}