{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Clayton G Zucker","gend":0,"currentgend":"","add":"14 SIGNATURE DR","city":"BRUNSWICK","state":"ME","zip":"04011","dob":"1944-03-01","age":"","mstatus":"","insh":"10000095473","cliId":"","pno":8022388464,"cno":"","email":"zekezucker@yahoo.com","ename":"","eno":"","pphy":"FLORY, ELIZABETH","ppno":2077984400,"pcpadd":"Martins Point Health Care,114 Bath Rd","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"14 SIGNATURE DR","madd2":"","madd3":"","mcity":"BRUNSWICK","mstate":"ME","mzip":"04011","pcpfaxno":2077984018,"pcpnpi":1659865970,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3FE6PD8EQ83","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N400","R918","M25551","M25552","S62201A","C61","E785","J479","S51012A","S80212A","M79644","M25641","R600","S63635D","S0081XA","N200","M79641","M47817","M47897","L259","M79672","M79671","H43813","Z13228","R053","K5790","E876","J4540","B349","G5702","M7061","R059","R067","R197","B351","M79674","M79675","L852","R262","Z23","M151","M25741","M19071","M7731","M19072","M7732","M5136","M47816","M4316","R6889","M8588","R29890","Z130","Z1159","S60512A","S60511A","S62347A","R079","N4231","Z1211","K449","Z4802","S6992XA","I517","M5450","R0781","S0003XA","R52","Z5321","R9720","R55","M79642","S2232XA","R1310","R12","M7062","M47896","M1611","N281","K5730","K439","M8580","S6991XA","J45909"],"date":["2024-06-28","2023-10-25","2025-06-04","2025-06-04","2025-11-19","2025-10-23","2025-07-28","2023-04-19","2025-05-11","2025-05-11","2022-12-19","2022-12-19","2022-12-19","2022-12-19","2025-10-05","2025-06-09","2024-05-09","2024-07-23","2024-07-23","2024-08-02","2024-05-09","2024-05-09","2025-05-29","2024-03-12","2025-08-20","2023-09-26","2025-02-18","2023-04-19","2025-02-28","2025-06-09","2025-07-28","2025-07-31","2025-02-18","2023-04-24","2025-10-09","2025-10-09","2025-10-09","2025-10-09","2025-10-09","2025-10-05","2024-05-09","2024-05-09","2024-05-09","2024-05-09","2024-05-09","2024-05-09","2024-01-04","2024-01-04","2024-01-04","2023-01-03","2024-10-24","2024-10-24","2024-03-12","2023-06-07","2025-10-05","2025-10-05","2025-10-29","2023-06-27","2023-10-23","2025-07-31","2023-08-04","2025-10-10","2025-10-05","2025-07-23","2024-01-04","2024-12-02","2025-10-05","2024-05-09","2023-06-26","2024-06-28","2025-10-05","2025-10-17","2024-12-02","2023-08-04","2023-08-04","2025-07-28","2025-07-28","2025-03-06","2025-05-31","2025-05-31","2025-05-31","2024-12-02","2022-11-17","2022-10-07"],"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":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)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":""}]}]}