{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Harold S Van Doren","gend":0,"currentgend":"","add":"98 BAGADUCE LN","city":"SEDGWICK","state":"ME","zip":"04676","dob":"1943-03-20","age":"","mstatus":"","insh":"10000089738","cliId":"","pno":2073598015,"cno":2074605560,"email":"haroldvandoren@mac.com","ename":"","eno":"","pphy":"PAINTER, DAVID M","ppno":2075462391,"pcpadd":"Northern Light Primary Care Blue Hill,57 Water St","pcpcity":"Blue Hill","pcpstate":"ME","pcpzip":"04614","pcpcounty":"","pcpid":"","pcpname":"MILBRIDGE MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"98 BAGADUCE LN","madd2":"","madd3":"","mcity":"SEDGWICK","mstate":"ME","mzip":"04676","pcpfaxno":2072888600,"pcpnpi":1033180476,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6YV4M18QY93","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R079","M1712","Z0000","C61","Z79899","I2699","M25562","R042","I2510","R600","R059","R5383","M170","M21162","Z8546","R0789","M9905","M9904","M5450","M9903","J40","M25462","C4441","D485","Z79818","M810","Z5112","L578","L821","H353130","H35363","H35033","Z13820","M8589","I2693","M160","C7951","H40013","H43393","H25813","I252","R0781","J9601","R6889","M19011","M25511","M25762","R0602","J302","I10","Z7901","Z859","M2011","K625","S79912D","M75101","Z8739","Z23","H538","L570","Z85828","L820","E8351","Z48817","M47817","M47816","A6920","Z5111","M25561","Z923"],"date":["2025-02-27","2025-07-30","2025-08-19","2025-07-08","2024-07-29","2025-05-29","2025-04-02","2025-02-28","2025-06-20","2025-02-28","2023-06-20","2023-06-20","2023-11-17","2023-11-17","2023-11-17","2025-02-25","2023-06-08","2023-06-08","2023-06-08","2023-06-08","2025-01-03","2023-10-10","2024-08-19","2024-07-23","2023-01-18","2025-01-02","2023-06-08","2025-01-20","2024-11-14","2024-12-11","2024-12-11","2025-07-08","2025-01-02","2023-12-27","2025-02-25","2023-05-31","2024-10-28","2025-07-08","2025-07-08","2025-07-08","2025-04-01","2025-02-28","2025-02-28","2023-11-08","2025-08-01","2025-08-01","2025-07-30","2025-02-27","2023-06-20","2025-02-27","2025-02-27","2025-02-27","2023-11-17","2025-02-28","2023-05-31","2025-08-01","2025-08-01","2023-10-04","2024-03-21","2025-08-06","2024-11-14","2025-01-20","2023-01-18","2024-07-23","2024-07-18","2024-07-18","2024-06-10","2022-09-14","2022-08-11","2022-06-22"],"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":[["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","NUBEQA","","","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":""}]}]}