{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Brent Harmon","gend":0,"currentgend":"","add":"1886 COASTAL RD","city":"BROOKSVILLE","state":"ME","zip":"04617","dob":"1955-07-12","age":"","mstatus":"","insh":"10000092526","cliId":"","pno":2073264173,"cno":"","email":"","ename":"","eno":"","pphy":"NIGHTINGALE, STEPHEN H","ppno":2074697371,"pcpadd":"33 Seaveys Way Ste 2,","pcpcity":"Ellsworth","pcpstate":"ME","pcpzip":"04605","pcpcounty":"","pcpid":"","pcpname":"BUCKSPORT REGIONAL HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1886 COASTAL RD","madd2":"","madd3":"","mcity":"BROOKSVILLE","mstate":"ME","mzip":"04617","pcpfaxno":2074697306,"pcpnpi":1538140520,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1A25DT4FH97","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z471","M7731","M2011","M19071","E039","J0100","G8929","M25562","M1711","G4733","M5136","M6281","R269","M47816","M170","H401430","M48062","M79604","I87391","I739","G603","M21161","E118","G8918","I10","I2510","M25512","R748","D7589","Z01818","E1142","M1712","K7581","E119","M5417","H401434","M249","M19072","L03115","S4992XA","H2589","Z961","K529","M12812","Z96652","M5126","M4726","M21162","M5116","M4316","M19012","R188","L03119","M25461","Z96651","G4730","K219","A4902","M79671","Z6832","Z01812","S46012A","Z981","M5416","M5442","Z0101","H524","Z23","M722","Z7984","M25561","M5450","M25462","M79672","Z96653","G5792","M7989","R600"],"date":["2025-02-04","2023-08-11","2023-08-11","2023-08-11","2025-07-29","2024-10-16","2023-05-17","2024-08-12","2024-12-05","2025-09-11","2023-01-17","2024-08-12","2024-08-12","2023-11-10","2024-10-28","2022-10-18","2025-04-07","2023-03-21","2022-11-08","2023-05-23","2023-02-09","2024-12-05","2025-03-19","2024-12-05","2024-12-05","2024-12-05","2024-05-28","2023-03-14","2025-07-29","2024-11-07","2024-01-17","2024-06-06","2025-09-05","2024-09-04","2023-04-18","2025-03-10","2024-01-19","2023-08-11","2025-03-19","2024-01-19","2022-10-18","2022-10-18","2025-06-23","2024-04-17","2024-07-05","2023-10-27","2023-11-10","2024-06-06","2023-11-10","2023-11-10","2024-04-17","2023-03-14","2025-03-21","2024-12-19","2024-12-19","2024-12-05","2024-06-06","2024-04-05","2023-08-11","2023-07-03","2024-04-23","2024-02-02","2023-11-10","2025-06-09","2023-11-10","2024-09-04","2024-09-04","2025-07-29","2023-10-03","2023-10-03","2024-04-05","2023-08-07","2024-04-05","2023-08-07","2025-01-31","2022-10-04","2022-09-29","2022-09-29"],"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":[["","","DORZOLAMIDE-TIMOLOL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","JANUMET XR","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","SAXAGLIPTIN-METFORMIN ER","","","Select","Select",""],["","","ONETOUCH VERIO FLEX METER","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","DIPHENOXYLATE-ATROPINE","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TRANEXAMIC ACID","","","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":{"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}