{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Steven G Lavallee","gend":0,"currentgend":"","add":"147 METCALF RD","city":"WINTHROP","state":"ME","zip":"04364","dob":"1956-11-06","age":"","mstatus":"","insh":"10000089198","cliId":"","pno":2074462989,"cno":"","email":"slavallee52@yahoo.com","ename":"","eno":"","pphy":"POWERS, BRETT C","ppno":2073386900,"pcpadd":"PO BOX 1599,","pcpcity":"BANGOR","pcpstate":"ME","pcpzip":"44021599","pcpcounty":"","pcpid":"","pcpname":"FAMILY MEDICINE INSTITUTE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 152","madd2":"","madd3":"","mcity":"WINTHROP","mstate":"ME","mzip":"04364","pcpfaxno":2073384974,"pcpnpi":1477059426,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6VU8G33HM63","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M4856XA","M51369","M5441","Z0000","I4891","R5383","Z131","Z0101","I480","E785","M25551","R195","M25562","M5136","E7800","M5416","Z1211","S299XXA","R002","D122","K5730","K648","M1611","M5450","M47816","S40012A","W208XXA","Y9389","K222","R1310","H5712","G8929","K449","S0502XS","Z01818","R6889","S32018A","X58XXXA","M1712","H353132","K219"],"date":["2025-11-03","2025-11-03","2025-11-03","2025-07-16","2025-07-16","2025-07-16","2025-07-16","2025-08-27","2025-10-29","2023-08-25","2023-10-20","2023-08-25","2023-08-25","2023-08-04","2024-12-06","2025-11-03","2024-09-20","2025-06-30","2024-04-03","2024-09-20","2024-09-20","2024-09-20","2023-11-15","2023-08-04","2023-08-04","2025-06-30","2025-06-30","2025-06-30","2024-04-26","2024-04-26","2023-10-20","2023-08-04","2024-04-26","2023-11-03","2024-04-25","2023-07-24","2025-11-03","2025-11-03","2024-05-31","2025-03-14","2024-04-26"],"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":[["","","OXYCODONE HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","TOBRAMYCIN-DEXAMETHASONE","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","CEPHALEXIN","","","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":""}]}]}