{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David A Dascanio","gend":0,"currentgend":"","add":"10 TRANQUIL COVE","city":"CASCO","state":"ME","zip":"04015","dob":"1956-07-24","age":"","mstatus":"","insh":"10000088184","cliId":"","pno":2076555722,"cno":"","email":"ddascan1@maine.rr.com","ename":"","eno":"","pphy":"BERGERON POULIN, CHARLES KEVIN","ppno":2076936106,"pcpadd":"76 HIGH ST,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407649","pcpcounty":"","pcpid":"","pcpname":"NAPLES FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 227","madd2":"","madd3":"","mcity":"SOUTH CASCO","mstate":"ME","mzip":"04077","pcpfaxno":2076934026,"pcpnpi":1992291249,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5KQ6G67CH77","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H3581","E113293","E1165","T1501XD","H401131","H04123","E119","M19072","Z794","J0190","S92062D","S92062A","N401","N393","N200","R059","H209","S92002A","N528","S61441A","S61411A","S92002D","R413","Z0184","I10","G4733","K047","I6529","E291","Z8679","I6523","Z961","E113291","J329","H4089","S0501XD","R0981","S0512XA","M7732","H5213","H524","H52203","T1501XA","S99912A","S8255XA","K0889","Z7189","R5383","H2512","H401121","E1122","M19031","I129","E1142","E669","K219","E785","H2511","H401111","K769","S6991XA","S63509A","M5450","Z87442"],"date":["2025-09-17","2025-09-15","2025-11-06","2023-11-01","2025-09-17","2024-10-24","2023-08-17","2023-10-16","2025-11-06","2023-10-05","2024-02-12","2023-10-16","2025-05-22","2025-05-22","2025-05-22","2023-12-29","2023-09-01","2023-06-09","2024-04-30","2024-08-29","2024-08-29","2023-06-09","2024-06-04","2025-03-17","2024-04-24","2025-11-07","2024-06-24","2023-03-14","2025-01-14","2023-02-27","2023-02-27","2023-04-27","2025-09-17","2024-10-14","2024-10-18","2024-10-18","2024-02-20","2024-03-04","2022-12-13","2023-04-27","2023-04-27","2023-04-27","2023-08-14","2022-11-29","2022-11-29","2024-07-29","2024-11-20","2024-10-07","2022-11-08","2022-11-08","2022-10-24","2022-10-24","2022-10-24","2022-10-24","2022-11-08","2022-11-08","2022-11-08","2022-09-13","2022-09-13","2022-09-13","2022-07-21","2022-07-21","2022-04-19","2022-04-19"],"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":[["","","MOUNJARO","","","Select","Select",""],["","","TESTOSTERONE CYPIONATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","NOVOLOG MIX 70-30 FLEXPEN","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY SENSOR","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FREESTYLE LIBRE 2 PLUS SENSOR","","","Select","Select",""],["","","ULTRA-FINE SHORT PEN NEEDLE","","","Select","Select",""],["","","LEVEMIR FLEXPEN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","INSULIN GLARGINE SOLOSTAR","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","RYBELSUS","","","Select","Select",""],["","","LAGEVRIO (EUA)","","","Select","Select",""],["","","UNIFINE PENTIPS PLUS","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","DIFLUPREDNATE","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","FREESTYLE TEST STRIPS","","","Select","Select",""],["","","FREESTYLE LIBRE 2 READER","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","DORZOLAMIDE-TIMOLOL","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","BRIMONIDINE TARTRATE","","","Select","Select",""],["","","LEVEMIR FLEXTOUCH","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","FREESTYLE FREEDOM LITE","","","Select","Select",""],["","","FREESTYLE LITE METER","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","TRULICITY","","","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":[]}},{"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":""}]}]}