{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Keith E Small","gend":0,"currentgend":"","add":"33 CASTINE RD","city":"ORLAND","state":"ME","zip":"04472","dob":"1955-10-05","age":"","mstatus":"","insh":"10000094477","cliId":"","pno":2074608772,"cno":"","email":"keith.e.small@gmail.com","ename":"","eno":"","pphy":"HENNER WALDEN, STACEY L","ppno":2074697371,"pcpadd":"Bucksport Regional Health Center,110 Broadway","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":"33 CASTINE RD","madd2":"","madd3":"","mcity":"ORLAND","mstate":"ME","mzip":"04472","pcpfaxno":2074697306,"pcpnpi":1548204183,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3M13DC1XT94","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H401113","H35033","H43393","H538","C61","H26493","H353211","H353121","H401131","H2589","H2512","H401121","H2511","H401111","E119","R6889","D849","Z940","Z48298","I10","Z5111","Z9079","Z923","H40053","H2513","E7800","Z460","Z87891","Z0000","N028","Z4822","I129","Z13820","M8589","E11311","Z131","H1713","L578","L821","D239","D229","H25813","S41112A","W228XXA","D1801","H353131","S61412A","R9721","S61419A","Z79818","E785","R7309","D899"],"date":["2025-01-09","2025-07-09","2025-07-09","2022-11-17","2025-07-08","2025-01-09","2025-08-14","2025-08-14","2025-07-09","2022-10-12","2024-10-15","2024-10-15","2024-10-29","2024-10-29","2025-03-20","2023-10-17","2025-03-06","2025-03-31","2023-07-19","2023-11-16","2024-05-10","2024-10-28","2024-10-28","2024-12-02","2024-09-19","2025-07-15","2024-12-10","2024-10-28","2024-09-27","2023-09-08","2023-11-16","2023-03-22","2024-11-21","2024-11-21","2023-11-28","2022-12-28","2024-06-27","2025-03-31","2025-03-31","2024-01-15","2025-03-31","2024-06-27","2025-02-08","2025-02-08","2023-01-16","2025-07-09","2025-02-08","2024-03-12","2025-02-19","2023-04-10","2022-08-25","2022-08-25","2022-09-01"],"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":[["","","LATANOPROST","","","Select","Select",""],["","","TACROLIMUS","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","MYCOPHENOLATE MOFETIL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","BRIMONIDINE TARTRATE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","ALPHAGAN P","","","Select","Select",""],["","","LUMIGAN","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","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":[]}},{"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":""}]}]}