{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Richard T Pomelow","gend":0,"currentgend":"","add":"100 HERITAGE HILL","city":"PALERMO","state":"ME","zip":"04354","dob":"1956-01-20","age":"","mstatus":"","insh":"10000084588","cliId":"","pno":2074413234,"cno":"","email":"declined@11042024.com","ename":"","eno":"","pphy":"GUZZETTI, PETER D","ppno":2076238434,"pcpadd":"Kennebec Internal Medicine,9 Glenridge Dr","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"KENNEBEC INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"100 HERITAGE HILL","madd2":"","madd3":"","mcity":"PALERMO","mstate":"ME","mzip":"04354","pcpfaxno":2076214370,"pcpnpi":1306885207,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3A34P51JY91","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":["R569","R7989","F330","R079","R739","I10","R5383","N400","E785","I739","Z0000","Z125","Z23","R9430","I6782","R6889","I6523","G9340","R413","Z91148","R4182","E559","E539","G9341","G40109","G309","G4089","Z789","R9401","G40209","Z79899","Z87891","G40909","M79642","M79641","F69","R9439","R531","S0181XA","R0989","M109"],"date":["2025-06-26","2023-07-14","2023-08-17","2023-06-05","2025-03-20","2025-03-20","2025-03-20","2023-03-02","2025-06-26","2023-03-02","2025-03-20","2025-03-20","2023-03-02","2023-06-05","2024-10-29","2024-12-23","2024-10-27","2023-08-25","2025-06-26","2023-08-13","2023-08-13","2025-03-20","2025-03-20","2024-10-27","2024-11-08","2024-10-09","2024-10-28","2024-10-28","2023-04-27","2025-03-05","2025-03-05","2025-04-02","2024-10-27","2025-04-02","2025-04-02","2023-08-13","2023-05-12","2024-10-27","2024-10-27","2023-03-28","2023-03-02"],"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":[["","","LEVETIRACETAM","","","Select","Select",""],["","","PHENYTOIN SODIUM EXTENDED","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","SF 5000 PLUS","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","SHINGRIX","","","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":""}]}]}