{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David A Wainwright","gend":0,"currentgend":"","add":"408 RIVER RD","city":"CANTON","state":"ME","zip":"04221","dob":"1947-03-15","age":"","mstatus":"","insh":"10000084313","cliId":"","pno":2075972363,"cno":"","email":"Macneill1949@gmail.com","ename":"","eno":"","pphy":"SWEETSER, MICHELLE","ppno":"","pcpadd":"4 CLEMENT WAY,","pcpcity":"BELGRADE","pcpstate":"ME","pcpzip":"49174370","pcpcounty":"","pcpid":"","pcpname":"WESTERN MAINE FAMILY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"408 RIVER RD","madd2":"","madd3":"","mcity":"CANTON","mstate":"ME","mzip":"04221","pcpfaxno":2074953353,"pcpnpi":1568820264,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3QM8DX1DU53","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":["I10","R600","K5732","I499","E039","R059","K5792","N179","I4811","R0602","J13","Z23","K5900","R339","Z930","L570","X32XXXA","L814","L821","D485","I4891","Z6832","Z430","I447","J398","Z0101","H5213","Z87891","Z0000","H52223","H524","H2513","H43813","E119","I4819","R7303","C321","E785","I7140","Z136","I517","I429","R051","Z20822","Z08","Z8521","Z923","Z9221","C329"],"date":["2024-09-17","2023-11-21","2024-01-20","2025-03-04","2024-02-22","2023-10-20","2024-01-31","2024-01-31","2025-03-04","2023-10-20","2025-10-25","2025-09-23","2024-01-20","2024-01-20","2024-04-10","2025-03-12","2025-03-12","2025-03-12","2025-03-12","2024-03-06","2024-06-04","2024-09-17","2024-01-17","2025-10-16","2025-03-18","2025-01-29","2025-01-29","2025-01-16","2025-09-23","2023-07-24","2023-07-24","2023-07-24","2023-07-24","2023-07-24","2023-11-08","2023-09-13","2023-09-13","2023-09-13","2024-05-08","2023-02-01","2025-06-24","2025-11-11","2022-12-05","2022-12-05","2023-04-19","2023-04-19","2023-04-19","2023-04-19","2022-09-27"],"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":[["","","FINASTERIDE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","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":{"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":""}]}]}