{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Raymond R Deleo","gend":0,"currentgend":"","add":"8 CRICKETT LN","city":"BIDDEFORD","state":"ME","zip":"04005","dob":"1952-09-12","age":"","mstatus":"","insh":"10000088580","cliId":"","pno":2072297657,"cno":"","email":"Rdeleo0912@gmail.com","ename":"","eno":"","pphy":"LETELLIER, TERESA","ppno":2072831441,"pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"8 CRICKETT LN","madd2":"","madd3":"","mcity":"BIDDEFORD","mstate":"ME","mzip":"04005","pcpfaxno":2075231136,"pcpnpi":1629431622,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8WQ3TY7MW88","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z713","I10","C4361","R262","E6601","Z6834","R6889","I351","E66811","G4733","E88819","I429","M546","M5134","M47814","R0683","Z96651","E66813","Z6833","M65352","Z01818","J9811","R918","D492","L814","D225","L821","D1801","G301","I493","F02A0","F411","M5137","M47816","Z471","Z96641","F329","F419","I77810","M1711","M5450","Z0100","C439","Z23","R2231","R2232","R7989","Z6837","Z79899","C4360","E785","F418","R4182","C4359","R140","Z6841","M5459","R413","Z85820","N281","C761","R4189","E669","D2261","R258","C44602","I110","I509","I43","I499","Z13220","R109","Z136"],"date":["2025-09-04","2025-06-05","2025-11-17","2023-04-19","2025-06-05","2025-03-05","2023-10-28","2025-07-28","2025-05-07","2025-08-13","2025-05-07","2022-12-06","2024-05-03","2024-02-15","2024-02-15","2024-06-05","2023-10-18","2025-09-04","2025-09-04","2023-10-23","2025-11-14","2025-11-14","2025-11-14","2024-11-12","2025-05-06","2025-05-06","2025-05-06","2025-05-06","2025-06-03","2025-01-13","2025-06-03","2023-03-21","2023-10-18","2023-10-18","2023-10-18","2023-10-18","2025-04-14","2025-04-14","2024-11-27","2023-10-18","2024-02-09","2024-07-17","2025-11-17","2025-09-18","2025-09-19","2025-09-19","2025-04-14","2024-06-05","2025-10-09","2025-10-09","2025-01-10","2025-01-10","2025-01-10","2025-09-19","2025-03-12","2025-06-05","2024-05-03","2025-01-06","2025-10-13","2024-03-14","2025-09-19","2024-12-30","2024-06-04","2025-01-10","2024-06-05","2025-10-03","2025-01-10","2025-01-10","2025-01-10","2022-10-18","2022-09-06","2022-09-06","2022-09-06"],"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":[["","","ONDANSETRON ODT","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","MEMANTINE HCL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","DULOXETINE HCL","","","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":""}]}]}