{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Philip A Deletetsky","gend":0,"currentgend":"","add":"133 THIRD ST","city":"AUBURN","state":"ME","zip":"04210","dob":"1954-10-09","age":"","mstatus":"","insh":"10000091630","cliId":"","pno":2073464096,"cno":2077828181,"email":"phildeletetsky@gmail.com","ename":"","eno":"","pphy":"STADNICKI, MICHAEL R","ppno":2077537655,"pcpadd":"12 HIGH ST,STE 302","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407634","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"133 THIRD ST.","madd2":"","madd3":"","mcity":"AUBURN","mstate":"ME","mzip":"04210","pcpfaxno":2077537656,"pcpnpi":1831179803,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6AC0U07EV46","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S76311A","I499","M25511","M1710","I4891","M25561","G4733","K429","I10","N401","R059","Z0000","R001","I872","I8001","I4719","R000","M2550","Z01810","Z0389","M160","M9905","S336XXA","M9903","M5459","M353","M1712","Z7952","Z01818","M1711","I878","M069","R350","N3281","N400","Z09","C44519","R600","L539","M170","H9390","I484","L570","D649","L989","Z7689","I2510","M25562","L821","Z0101","H25813","R1031","Z96651","E785","K7689","L820","Z471","Z96641","R52","I4892","Z79899","R2241","Z139","I440","J329","J40","M25569","I700","M19011","M5136","M47817","M47816","M5450","R351","K5900","M25512","B079","L600","Z136","G8918","M169","M25551","Z4889","M11262","Z7901","H2513","H5203","H52223","H524","I70219"],"date":["2025-06-02","2025-06-11","2025-10-01","2022-11-29","2025-07-03","2024-02-02","2025-10-24","2024-12-08","2025-07-03","2024-12-03","2024-04-15","2024-12-05","2025-04-02","2025-04-01","2025-04-01","2025-06-13","2024-08-20","2023-12-15","2023-08-18","2025-05-13","2025-05-13","2024-10-07","2024-10-07","2024-10-07","2024-10-07","2025-05-20","2025-08-05","2025-05-02","2023-09-12","2023-09-12","2024-10-15","2025-09-08","2024-06-24","2025-07-15","2025-07-15","2024-07-26","2025-10-24","2025-04-03","2025-08-21","2023-05-26","2024-10-15","2025-07-03","2024-10-15","2025-01-22","2025-10-24","2025-07-24","2024-01-25","2022-12-22","2022-11-29","2024-09-03","2024-09-03","2025-07-09","2024-05-02","2024-11-29","2024-12-08","2025-07-24","2023-09-08","2023-09-08","2023-11-09","2023-10-20","2025-08-05","2023-11-09","2024-07-09","2023-10-20","2024-04-15","2024-04-15","2024-05-02","2024-01-25","2023-01-03","2023-01-03","2023-01-03","2023-01-03","2023-01-03","2024-06-11","2024-06-11","2023-01-03","2025-03-27","2023-02-21","2023-11-18","2023-09-12","2022-11-29","2022-10-25","2022-10-25","2022-10-28","2022-09-19","2022-08-30","2022-08-30","2022-08-30","2022-08-30","2022-08-31"],"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":[["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","MIRABEGRON ER","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","METHOTREXATE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","GEMTESA","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HYDROCORT","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","CONSTULOSE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)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":""}]}]}