{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kenneth E Gleason","gend":0,"currentgend":"","add":"471 S GOULDSBORO RD","city":"GOULDSBORO","state":"ME","zip":"04607","dob":"1944-04-09","age":"","mstatus":"","insh":"10000093484","cliId":"","pno":8022891989,"cno":"","email":"Ken.gleason2@gmail.com","ename":"","eno":"","pphy":"TAINTER, RUTH B","ppno":2076672288,"pcpadd":"Bucksport Regional Health Center,37 Commerce Park","pcpcity":"Bucksport","pcpstate":"ME","pcpzip":"04416","pcpcounty":"","pcpid":"","pcpname":"BUCKSPORT REGIONAL HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"471 S GOULDSBORO RD","madd2":"","madd3":"","mcity":"GOULDSBORO","mstate":"ME","mzip":"04607","pcpfaxno":2076676888,"pcpnpi":1134438625,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5J13FJ4CT84","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F411","E119","H04123","L570","L820","L578","L308","Z139","H01022","H01025","H18513","Z5189","Z713","I2510","R5383","M19011","Z951","R9431","K2090","K319","I10","R6889","N400","Z1211","R479","Z86010","K5730","R1310","Z23","E8352","I351","Z7982","Z125","M25511","E1140","G459","K219","J069","F341","R9082","I6523","Z8673","F419","M5450","I639","I744","C61","B349","M19072","M7732","M79672"],"date":["2025-08-27","2025-06-18","2024-12-11","2024-12-18","2024-12-18","2023-12-13","2023-12-13","2023-10-26","2023-12-13","2023-12-13","2023-12-13","2025-04-02","2023-04-20","2024-07-03","2024-01-03","2025-06-04","2024-07-03","2022-12-06","2023-06-29","2023-06-29","2024-12-05","2023-12-28","2024-10-31","2023-06-29","2023-10-03","2023-06-29","2023-06-29","2023-06-29","2023-09-12","2024-09-18","2023-10-25","2024-06-18","2024-10-31","2025-06-04","2022-10-27","2024-01-12","2023-04-04","2025-07-03","2024-02-28","2023-11-02","2023-11-02","2023-11-02","2023-05-12","2024-07-01","2024-01-12","2024-01-12","2022-09-27","2022-09-30","2022-08-16","2022-08-16","2022-08-16"],"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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","MOMETASONE FUROATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","DESONIDE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","SOD SULF-POTASS SULF-MAG SULF","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","PAXLOVID","","","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":{"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":""}]}]}