{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David P Matthews","gend":0,"currentgend":"","add":"86 RUMFORD AVE","city":"WOODSTOCK","state":"ME","zip":"04219","dob":"1953-01-27","age":"","mstatus":"","insh":"10000094386","cliId":"","pno":9783376108,"cno":"","email":"dpauldance6108@outlook.com","ename":"","eno":"","pphy":"MERCIER, CHRISTOPHER F","ppno":"","pcpadd":"Martins Point Health Care,331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 306","madd2":"","madd3":"","mcity":"BRYANT POND","mstate":"ME","mzip":"04219","pcpfaxno":"","pcpnpi":1396151619,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1VW8NP8GH22","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":["K319","K219","K222","K449","K2950","R079","H35353","H40023","H35373","E113293","I10","R0602","G4733","E7800","E1142","Z794","E785","R0609","Z1211","D128","E1169","G459","R4701","I6782","R410","L820","L298","L821","L814","Z125","E1140","E559","H01119","I071","R0600","E119","R809","A084","R0683","G4719","R590","J479","J849","I2510","R9431","R413","I6523","R9089","E041","F411","Z961","H2512","H269","E1136","Z01812","Z9841","H25012","H2511","Z23"],"date":["2025-06-06","2025-06-06","2025-06-06","2025-06-06","2025-06-06","2025-05-13","2025-03-03","2025-03-03","2025-03-03","2025-03-03","2025-09-09","2023-02-13","2023-05-10","2025-09-09","2024-04-23","2025-09-09","2024-04-23","2023-02-08","2023-06-21","2023-06-21","2024-04-16","2025-08-20","2025-08-20","2025-08-20","2025-08-20","2024-09-19","2024-09-19","2024-09-19","2024-09-19","2024-04-10","2023-02-01","2023-02-01","2023-06-07","2023-02-13","2023-02-13","2025-09-09","2023-04-06","2023-05-08","2023-05-10","2023-05-10","2025-08-08","2025-08-08","2025-08-08","2025-08-08","2025-04-28","2024-10-16","2025-08-04","2025-08-04","2025-08-04","2024-12-10","2022-09-16","2022-05-18","2022-05-18","2022-05-18","2022-05-15","2022-05-06","2022-05-06","2022-04-13","2022-03-29"],"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":[["","","TRESIBA FLEXTOUCH U-100","","","Select","Select",""],["","","ATOMOXETINE HCL","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","METOCLOPRAMIDE HCL","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","ULTRA-FINE NANO PEN NEEDLE","","","Select","Select",""],["","","DEXCOM G6 TRANSMITTER","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","DEXCOM G6 SENSOR","","","Select","Select",""],["","","DEXCOM G7 RECEIVER","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","BROMFENAC SODIUM","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHET ER","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"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":{"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":""}]}]}