{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Louis C Parent","gend":0,"currentgend":"","add":"69 LINCOLN POINT RD","city":"WAYNE","state":"ME","zip":"04284","dob":"1956-08-21","age":"","mstatus":"","insh":"10000088677","cliId":"","pno":2076200935,"cno":"","email":"mandmred@msn.com","ename":"","eno":"","pphy":"GRASSMANN, JEFFREY L","ppno":2078282402,"pcpadd":"100 GANNETT DR STE C,","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41065900","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 122","madd2":"","madd3":"","mcity":"WAYNE","mstate":"ME","mzip":"04284","pcpfaxno":2078741483,"pcpnpi":1750580486,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6R52RD5VG09","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R6889","Z0100","K642","K641","K594","K6289","K644","L290","H02055","H1132","H2511","Z0000","U071","Z0101","L570","J029","N281","E7800","Z0001","Z13228","R109","H2512","Z125","H5213","B029","H903","M19012","M1611","R9389","K5730","N400","Z961","D492","H2513","H35372","Z03818","M75102","M25512","M25551","Z1211","Z1212","B0229","R21"],"date":["2023-06-02","2024-06-05","2023-07-12","2023-07-12","2023-07-12","2023-07-12","2022-12-07","2022-12-07","2025-11-06","2025-11-06","2024-11-25","2023-11-15","2024-12-09","2024-09-16","2024-03-15","2025-05-01","2025-01-30","2025-01-06","2025-01-06","2025-01-06","2025-01-10","2024-12-03","2023-11-15","2023-06-02","2023-10-04","2025-05-07","2025-03-06","2025-03-06","2025-01-30","2025-01-10","2025-01-10","2025-01-06","2024-03-15","2025-01-06","2025-01-06","2025-05-01","2025-03-06","2025-03-06","2025-03-06","2022-11-17","2022-11-17","2022-04-08","2022-04-08"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","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":""}]}]}