{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michael A Connolly","gend":0,"currentgend":"","add":"8 VENTURE WAY","city":"KENNEBUNKPORT","state":"ME","zip":"04046","dob":"1956-11-22","age":"","mstatus":"","insh":"10000095317","cliId":"","pno":2079852451,"cno":"","email":"mikeconnolly56@icloud.com","ename":"","eno":"","pphy":"SCOPAZ, KRISTEN A","ppno":2078837926,"pcpadd":"Whole Medicine,20 Mussey Rd Ste 2","pcpcity":"Scarborough","pcpstate":"ME","pcpzip":"04074","pcpcounty":"","pcpid":"","pcpname":"WHOLE MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"8 VENTURE WAY","madd2":"","madd3":"","mcity":"KENNEBUNKPORT","mstate":"ME","mzip":"04046","pcpfaxno":2078831925,"pcpnpi":1114171857,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9UV8NE9ET59","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D485","L448","E1165","Z23","I10","M25511","R739","E1121","E113299","M79604","S76301D","S46091D","M7918","L570","R197","M79661","E113291","J309","J45909","C569","Z125","R350","Z1212","Z1211","M75101","M75121","Z0000","N401","R1084","E119","R748","E6601","Z136","Z87891","Z4682","K5989","K6389","S76391A","M25551","K56609","R109","R531","K529","N3281","S4990XA","E8352","S4991XA","Z0101","S79911A","Z139","M19011","R7989"],"date":["2024-06-11","2024-06-11","2025-09-12","2022-12-06","2024-12-10","2025-05-06","2025-04-03","2025-04-03","2025-04-03","2025-02-03","2024-11-07","2024-11-07","2024-09-05","2025-06-18","2025-02-06","2023-08-30","2025-05-14","2024-06-04","2024-06-04","2024-06-04","2024-05-16","2024-05-16","2024-07-15","2024-07-15","2024-06-11","2023-02-15","2024-04-30","2024-12-11","2023-07-11","2023-07-11","2024-09-04","2023-05-25","2025-05-20","2025-05-20","2023-06-19","2023-06-18","2023-06-19","2024-11-18","2024-11-18","2023-06-19","2023-06-18","2022-12-30","2023-06-19","2024-12-11","2024-10-02","2025-09-12","2024-10-02","2025-05-14","2024-09-05","2025-09-12","2022-05-27","2022-06-27"],"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":[["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LABETALOL HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","FREESTYLE LIBRE 3 READER","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","ONETOUCH VERIO FLEX METER","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","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":""}]}]}