{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Norman L Lagasse","gend":0,"currentgend":"","add":"483 Albert St","city":"Madawaska","state":"ME","zip":"04756","dob":"1960-12-03","age":"","mstatus":"","insh":"10000094158","cliId":"","pno":2077286647,"cno":"","email":"","ename":"","eno":"","pphy":"Steven J Albert","ppno":2077287300,"pcpadd":"460 Main Street,Suite 104","pcpcity":"Madawaska","pcpstate":"ME","pcpzip":"04756","pcpcounty":"","pcpid":"","pcpname":"Pines St John Valley Health Center","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"483 Albert St","madd2":"","madd3":"","mcity":"Madawaska","mstate":"ME","mzip":"04756","pcpfaxno":2077287614,"pcpnpi":1225006778,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9MJ1JU6RF39","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4820","J441","E7800","R197","I4891","I440","I4892","I4719","E119","B0052","R0602","I10","E785","M7910","L299","B0050","G629","R600","R200","R9720","I493","I491","I4710","I452","H16101","E1136","H2589","H00022","M5416","R1084","K760","Z01812","M79671","M5450","H259","G5752","R202","Z1152","G6289","M5418","J069","R233","R17","E1121","E1159","M79672","I4819","L84","R052","H1132","M7662","Z7901","Z87891","I517","R002","E279"],"date":["2024-05-02","2024-04-02","2025-04-07","2023-03-24","2024-08-20","2024-02-17","2024-08-27","2024-02-17","2025-07-10","2023-04-24","2025-05-02","2025-01-22","2023-08-21","2023-01-17","2023-09-14","2023-05-11","2025-03-25","2025-03-07","2023-08-03","2025-02-12","2024-11-08","2024-11-08","2024-11-08","2024-11-08","2023-05-11","2023-04-28","2023-04-28","2023-04-14","2025-07-11","2024-11-06","2023-08-30","2025-05-02","2024-10-31","2023-06-29","2023-05-11","2025-02-26","2023-02-01","2023-03-23","2023-08-03","2023-08-03","2024-12-09","2023-01-10","2024-04-26","2025-04-30","2025-04-30","2024-10-31","2024-08-27","2025-01-23","2024-03-21","2025-02-28","2025-03-25","2025-03-25","2023-05-11","2025-05-02","2024-02-09","2025-07-15"],"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":[["","","FUROSEMIDE","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","DILTIAZEM HCL","","","Select","Select",""],["","","BREZTRI AEROSPHERE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","TOBRAMYCIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TRIFLURIDINE","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}