{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Leo R Ouellette","gend":0,"currentgend":"","add":"11 JENNIFER LN","city":"WELLS","state":"ME","zip":"04090","dob":"1957-01-25","age":"","mstatus":"","insh":"10000093010","cliId":"","pno":2075771367,"cno":"","email":"lcruise55@gmail.com","ename":"","eno":"","pphy":"ZEITLIN, JAMES","ppno":2077745816,"pcpadd":"100 FODEN ROAD WEST,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41062327","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"11 JENNIFER LN","madd2":"","madd3":"","mcity":"WELLS","mstate":"ME","mzip":"04090","pcpfaxno":2078741483,"pcpnpi":1194794859,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9AT5TD2XK91","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H40013","I10","H43391","L570","D229","L821","Z719","Z23","L853","L578","J0100","I2510","Z955","J40","Z0001","R0789","I4892","I4710","D123","Z86010","D124","K5730","Z0184","R079","E785","I4891","I5030","I358","E7800","Z125","Z1159","D122","I5189","R030","I25110","R6889","I998","I200","F439","R748","Z5181","E782","N401","R197","Z0101"],"date":["2024-08-29","2025-04-09","2024-08-29","2025-06-24","2025-06-24","2025-06-24","2025-06-24","2025-04-17","2025-04-22","2025-04-22","2024-04-10","2025-03-14","2024-05-01","2023-03-20","2025-02-05","2024-02-22","2025-03-14","2024-03-20","2023-06-23","2023-06-23","2023-06-23","2023-06-23","2025-04-17","2024-02-22","2025-03-14","2025-03-14","2024-02-23","2024-02-23","2025-02-05","2025-02-05","2024-02-02","2023-06-23","2024-02-22","2024-02-22","2024-02-23","2023-11-24","2024-02-23","2024-02-24","2022-11-30","2025-03-06","2025-02-05","2023-01-27","2023-01-27","2022-09-02","2022-08-12"],"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":[["","","NITROGLYCERIN","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","IRBESARTAN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","MODERNA 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":""}]}]}