{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"William E Horrocks","gend":0,"currentgend":"","add":"46 WITCHTROT RD","city":"YORK","state":"ME","zip":"03909","dob":"1954-11-12","age":"","mstatus":"","insh":"10000095470","cliId":"","pno":9784208886,"cno":"","email":"declined@061523.com","ename":"","eno":"","pphy":"BRAND, ANNA O","ppno":2073638430,"pcpadd":"York Family Practice,127 Long Sands Rd Ste 11","pcpcity":"York","pcpstate":"ME","pcpzip":"03909","pcpcounty":"","pcpid":"","pcpname":"YORK FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"46 WITCHTROT RD","madd2":"","madd3":"","mcity":"YORK","mstate":"ME","mzip":"03909","pcpfaxno":2073512216,"pcpnpi":1912438102,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4MH2W91KA95","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N529","Z472","I10","R6889","M1812","Z4789","D1801","L821","L814","L570","M180","D485","R7989","L03113","T22232A","S40862A","E291","I788","D225","B078","L538","T8484XA","G8918","Z86010","D122","K635","Z09","R5383","H16143","Z1211","D2239","J45990","Z7189","S46912A","H04123","H16142","H02889","H5203","H52222","H53021","R0789","R232","L578","U071","H16041","J020","M19012","Z136","N4340","Z23","Z0000","Z0101"],"date":["2025-03-13","2025-03-11","2025-03-17","2023-01-01","2025-07-28","2025-07-28","2025-07-15","2024-11-05","2024-11-05","2025-09-16","2025-09-03","2025-06-10","2025-03-13","2025-07-24","2025-07-24","2025-06-04","2025-09-25","2025-04-15","2023-03-21","2023-03-21","2023-03-21","2025-03-11","2025-03-11","2022-12-09","2022-12-09","2022-12-09","2025-07-15","2024-06-24","2024-05-03","2022-12-09","2025-06-10","2024-03-08","2024-08-09","2023-07-26","2024-09-12","2024-09-12","2023-03-15","2023-03-15","2023-03-15","2023-03-15","2023-01-13","2024-03-09","2025-04-15","2025-01-08","2023-01-31","2023-05-27","2023-09-22","2022-10-25","2022-09-15","2022-09-22","2022-09-09","2022-07-22"],"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":[["","","TESTOSTERONE CYPIONATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","PAXLOVID (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":[]}},{"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":[]}]},{"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":""}]}]}