{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dennis P Peterson","gend":0,"currentgend":"","add":"31 CHLOE LYN LN","city":"BRUNSWICK","state":"ME","zip":"04011","dob":"1953-06-03","age":"","mstatus":"","insh":"10000093032","cliId":"","pno":2074085339,"cno":"","email":"maineman1p@aol.com","ename":"","eno":"","pphy":"SHEPHERD, AMBER","ppno":2077984400,"pcpadd":"Sheepscot Valley Health Center,114 Bath Rd","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"31 CHLOE LYN LN","madd2":"","madd3":"","mcity":"BRUNSWICK","mstate":"ME","mzip":"04011","pcpfaxno":2078282433,"pcpnpi":1477941425,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1UD6X12VC52","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E119","Z7901","Z23","I4891","D692","Z79899","D649","M1711","D693","I4819","I5032","I330","I517","I3481","I10","Z125","E785","B351","M79674","M79675","E1165","Z0000","H6123","S61402A","R590","K760","N281","Z96642","J209","H6121","Z79891","M170","G894","J449","R942","G629","J90","R0600","J432","R599","R918","J9811","R591","Z961","H25813","E6601","E1136","H25812","H25811","H2620","I509","E1151","E0842","Z0101","M47816","M25561","G8929","Z136","I77819"],"date":["2025-04-12","2024-11-07","2025-10-24","2025-01-09","2025-02-12","2025-04-12","2025-09-11","2025-03-19","2024-05-09","2024-06-10","2024-02-15","2025-06-11","2024-02-15","2024-02-15","2025-07-17","2024-01-22","2025-04-12","2024-02-26","2024-02-26","2024-02-26","2025-07-17","2025-04-17","2025-04-17","2024-05-09","2023-02-13","2023-01-25","2023-01-25","2023-01-25","2023-04-04","2023-04-04","2023-01-17","2025-11-11","2023-01-18","2025-07-17","2023-02-13","2023-02-13","2023-02-13","2022-11-07","2022-11-07","2022-11-07","2022-11-07","2022-10-20","2022-10-20","2022-07-20","2022-06-13","2022-06-13","2022-06-13","2022-06-13","2022-05-23","2022-05-23","2022-05-25","2022-05-23","2022-05-11","2022-03-30","2022-04-08","2022-04-08","2022-04-08","2022-02-24","2022-02-24"],"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":[["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","INSULIN SYRINGE","","","Select","Select",""],["","","LANTUS","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","ULTRA-FINE INSULIN SYRINGE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TRETINOIN","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","PRODIGY INSULIN SYRINGE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","ONGLYZA","","","Select","Select",""],["","","PIOGLITAZONE HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","GLIMEPIRIDE","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}