{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Richard R Hines","gend":0,"currentgend":"","add":"109 JACKSON HILL RD","city":"MINOT","state":"ME","zip":"04258","dob":"1959-06-21","age":"","mstatus":"","insh":"10000092979","cliId":"","pno":2072121960,"cno":"","email":"Oldputter2@yahoo.com","ename":"","eno":"","pphy":"RABY, NATHAN C","ppno":2079982100,"pcpadd":"Community Health Center,364 Maine St","pcpcity":"Poland","pcpstate":"ME","pcpzip":"04274","pcpcounty":"","pcpid":"","pcpname":"MINOT AVENUE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"109 JACKSON HILL RD","madd2":"","madd3":"","mcity":"MINOT","mstate":"ME","mzip":"04258","pcpfaxno":"","pcpnpi":1770528143,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5XT5J04TQ84","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1321","G8929","N2889","C642","E785","I10","Z1211","M9900","M9901","M9902","M9903","M542","M5450","M5432","R9341","H25813","D124","D123","Z86010","R310","Z800","M9904","Z0000","E6601","Z6838","E7800","K219","J069","C649","R6889","H903","R7989","Z20822","M5030","N3289","J8410","Z96643","R109","Z23"],"date":["2023-02-03","2025-11-03","2023-07-14","2025-07-31","2023-06-06","2024-08-19","2023-04-11","2025-11-03","2025-11-03","2025-11-03","2025-11-03","2025-11-03","2022-12-21","2025-08-25","2025-07-14","2025-10-27","2023-04-11","2023-04-11","2023-04-11","2023-06-04","2023-06-04","2025-08-25","2025-04-02","2024-08-19","2023-02-08","2023-02-08","2023-02-08","2023-01-24","2024-05-29","2023-10-23","2025-04-09","2023-07-20","2023-01-24","2024-08-19","2023-06-04","2023-06-04","2023-06-04","2023-06-04","2022-10-18"],"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":[["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","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":""}]}]}