{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donald E Stowell","gend":0,"currentgend":"","add":"385 GREELY ROAD EXT","city":"Cumberland Center","state":"ME","zip":"04021","dob":"1955-02-27","age":"","mstatus":"","insh":"10000088263","cliId":"","pno":2072722095,"cno":"","email":"dstowell7377@gmail.com","ename":"","eno":"","pphy":"BUSTAMANTE, ANTHONY","ppno":2078469013,"pcpadd":"InterMed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"385 GREELY ROAD EXT","madd2":"","madd3":"","mcity":"Cumberland Center","mstate":"ME","mzip":"04021","pcpfaxno":2075238586,"pcpnpi":1306229521,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4CC7VV6RK57","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I480","I4819","E785","R4182","Z950","I429","Z86010","K5730","E782","E0590","Z125","R7309","R29898","R7989","Z8619","E061","S61210D","I428","I493","H401332","I420","I4891","Z7901","D472","M2550","I110","I509","R0609","M79605","I361","M8589","I442","I483","Z79899","Z23","Z0001","M5126","M4726","R5383","M79604","M5450","Q2110","Z45010","S61310A","S62630A","M25641","M79644","M6281","R600","J984","N401","S62639B","R748","L814","L821","L570","E7800","Z8042","R0602","I071","D492","S6991XA","M7910","R6889","R17","I5040","I517","I5189","H26491","H401131"],"date":["2025-08-20","2025-09-22","2023-11-29","2023-11-29","2025-11-07","2023-11-30","2023-01-18","2023-01-18","2025-09-10","2025-09-10","2025-09-10","2025-09-10","2024-07-23","2024-08-13","2024-10-04","2024-12-17","2024-10-04","2025-04-08","2025-02-28","2025-10-21","2024-09-13","2024-09-08","2024-09-08","2025-06-10","2025-08-14","2023-06-22","2023-06-22","2024-03-12","2025-06-04","2025-01-29","2023-11-13","2025-04-08","2023-11-29","2023-11-29","2025-09-17","2025-09-17","2025-06-04","2025-06-04","2024-10-04","2024-12-04","2024-12-04","2023-09-14","2024-03-22","2024-09-10","2024-09-10","2024-11-01","2024-11-01","2024-11-01","2024-11-01","2023-11-03","2023-11-03","2024-09-08","2023-09-07","2023-06-14","2023-06-14","2023-06-14","2023-11-29","2024-09-04","2023-10-24","2023-09-06","2023-05-24","2024-09-08","2025-08-14","2022-11-17","2022-08-12","2022-08-25","2022-08-25","2022-08-25","2022-07-26","2022-06-20"],"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":[["","","SACUBITRIL-VALSARTAN","","","Select","Select",""],["","","BISOPROLOL FUMARATE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","LUMIGAN","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","ALFUZOSIN HCL ER","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","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":[]}},{"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":""}]}]}