{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Fred A Mayo","gend":0,"currentgend":"","add":"211 ELDRIDGE RD","city":"WELLS","state":"ME","zip":"04090","dob":"1949-01-08","age":"","mstatus":"","insh":"10000088150","cliId":"","pno":2073370940,"cno":"","email":"","ename":"","eno":"","pphy":"ADAMS, TODD","ppno":2076468386,"pcpadd":"York Hospital Internal Medicine of York,277 Post Rd","pcpcity":"Moody","pcpstate":"ME","pcpzip":"04054","pcpcounty":"","pcpid":"","pcpname":"YORK HOSPITAL INTERNAL MEDICINE OF YORK","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"211 ELDRIDGE RD","madd2":"","madd3":"","mcity":"WELLS","mstate":"ME","mzip":"04090","pcpfaxno":2076412855,"pcpnpi":1427165778,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7FY1T87HJ05","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5416","M47816","M48062","M5441","M5136","R5381","G4733","H6123","I2510","M48061","I10","I509","E119","M5126","M5135","H903","R051","R918","I700","R059","R262","M5450","H2511","R9439","R001","E66813","E6601","Z01818","E1165","I110","M4316","H25813","I5022","H25811","H25812","Z0189","I499","Z0101","H35371","M549","R0600","I517","M4807","H2512","G9519","I739","R7301","M7910","M546","K8012","Z9049","K8000","R945"],"date":["2025-07-23","2025-07-23","2024-04-25","2023-08-03","2023-11-20","2023-08-03","2025-05-19","2023-04-07","2025-04-24","2025-08-22","2023-07-07","2025-03-31","2025-07-15","2023-11-20","2023-11-20","2024-06-27","2025-03-31","2023-11-14","2023-11-20","2023-11-14","2023-11-20","2023-03-07","2023-06-27","2024-02-05","2024-01-15","2025-07-15","2023-08-01","2024-03-22","2025-04-10","2025-03-31","2025-07-23","2023-05-30","2022-10-31","2023-06-27","2023-07-07","2025-07-22","2025-04-27","2023-01-19","2023-01-19","2025-07-22","2023-11-20","2023-11-20","2023-11-20","2023-07-07","2022-09-14","2022-08-26","2022-08-16","2022-09-09","2022-07-22","2022-07-23","2022-07-27","2022-07-23","2022-07-22"],"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":[["","","TIZANIDINE HCL","","","Select","Select",""],["","","ARMODAFINIL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","FREESTYLE LIBRE 3 SENSOR","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FREESTYLE LIBRE 3 READER","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","BUMETANIDE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","MOUNJARO","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}