{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Douglas R Hermann","gend":0,"currentgend":"","add":"42 EBEN HILL RD","city":"YARMOUTH","state":"ME","zip":"04096","dob":"1953-10-14","age":"","mstatus":"","insh":"10000092109","cliId":"","pno":2074410577,"cno":"","email":"dhermann@ymanandsimpson.com","ename":"","eno":"","pphy":"AIKEN, DOUGLAS","ppno":2078469013,"pcpadd":"Intermed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"42 EBEN HILL RD","madd2":"","madd3":"","mcity":"YARMOUTH","mstate":"ME","mzip":"04096","pcpfaxno":2078741483,"pcpnpi":1093774119,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9JX8NA2EP57","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R202","R6889","M5416","M2560","M6281","H2513","R197","R351","R1084","E7800","D509","N400","M1712","G8918","Z79899","Z23","M79605","R634","Z471","Z96652","M48061","R195","A000","Z0000","Z01818","R7301","J309","H903","Z86010","N281","M47816","M5126","A084","K5730","L03011","H5203","N289","M7022","M25462","R21","S50361A","W57XXXA","J029","K219","F419","R350","M25562","S83207D","M25662","Z98890","Z09","S83242D","S83232A","R4182","S83202D","M94262","Z01812","Z20822","Z125","S83242A","M25569"],"date":["2025-04-03","2023-04-19","2023-12-05","2023-02-15","2023-02-15","2025-09-03","2025-07-16","2025-03-13","2025-07-16","2025-06-26","2025-03-11","2025-03-13","2023-05-01","2023-05-01","2023-05-01","2024-03-19","2022-12-06","2025-07-16","2023-12-05","2023-12-05","2023-12-05","2025-07-15","2023-05-03","2025-03-18","2023-04-03","2025-03-11","2023-03-14","2023-12-04","2022-11-29","2023-04-18","2023-03-30","2023-03-30","2025-07-01","2025-07-01","2023-10-09","2025-09-03","2023-04-18","2024-04-02","2023-05-16","2024-05-06","2024-05-06","2024-05-06","2025-08-12","2023-05-01","2023-05-01","2025-03-13","2022-10-19","2022-08-25","2022-08-25","2022-06-14","2022-05-12","2022-05-02","2022-05-02","2022-05-02","2022-05-02","2022-05-02","2022-04-29","2022-04-29","2022-03-01","2022-03-03","2022-01-11"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(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":""}]}]}