{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Stephen P Bolduc","gend":0,"currentgend":"","add":"7 ANNAS WAY","city":"AUGUSTA","state":"ME","zip":"04330","dob":"1954-03-05","age":"","mstatus":"","insh":"10000095937","cliId":"","pno":2073140746,"cno":"","email":"","ename":"","eno":"","pphy":"CLARK, MICHAEL E","ppno":2078615000,"pcpadd":"Maine Dartmouth Family Medicine,149 North St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"MAINE DARTMOUTH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"7 ANNAS WAY","madd2":"","madd3":"","mcity":"AUGUSTA","mstate":"ME","mzip":"04330","pcpfaxno":2078615101,"pcpnpi":1053387936,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7GG5P31PJ51","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M7989","M25532","M1812","C220","K7460","E1122","C229","R918","Z7722","G8929","M47816","K2950","R933","K2090","N2889","R590","I129","N1832","Z7985","E119","M720","I83022","L97222","S80812S","I878","Z4800","K8020","D861","Z01818","I898","I080","Z4789","R161","L989","N390","B9620","R310","Z85528","L820","I8391","M24542","I781","I209","K8080","I10","S91302A","X58XXXA","Z01810","M7502","Z7984","I422","R600","K769","R160","C641","Z905","H903","R162","R1900","M19012","M25512","N1830","Z8553","M4726","M25642","M25612","N3281","Z0000","M48061","M5136","M5450","N401","Z923","I440","I444","I350","K225","K2289","R932","R519","D3131","H527","G319","J322","Z0389","Z1389","K7689","R9089","M65352","M65351","E1165","S81802A","R5383","M65359","M19041","M24541","L97228","R3911","R591","I2510","R935","E669","Z1331","M5135","M47814","L259","M25511"],"date":["2024-01-17","2024-01-17","2024-01-17","2025-10-29","2025-10-29","2025-08-14","2025-09-08","2024-06-27","2023-12-20","2025-10-30","2025-10-07","2023-12-15","2023-12-15","2023-12-15","2024-06-27","2024-06-27","2025-05-01","2025-05-01","2025-05-01","2025-01-16","2024-01-17","2023-07-12","2023-07-05","2023-07-12","2023-07-12","2023-06-28","2025-08-05","2024-02-16","2025-05-05","2024-02-16","2025-04-30","2024-01-02","2025-01-28","2025-05-13","2024-01-05","2024-01-05","2024-01-05","2025-04-28","2025-05-13","2023-05-31","2023-12-07","2023-05-24","2023-10-16","2023-10-16","2024-02-16","2023-06-27","2023-06-27","2025-04-30","2025-02-17","2023-09-05","2023-10-03","2023-10-03","2025-10-13","2025-08-05","2025-10-13","2024-07-09","2025-10-14","2024-08-05","2025-08-05","2024-11-18","2024-11-18","2025-10-29","2025-10-29","2025-10-30","2024-10-30","2024-10-30","2025-11-12","2025-07-28","2024-09-24","2024-09-24","2024-09-24","2024-10-04","2025-08-27","2024-02-16","2024-02-16","2024-02-16","2025-03-03","2025-03-03","2025-03-06","2023-04-05","2023-05-15","2023-05-15","2025-04-04","2025-04-04","2025-05-15","2025-04-02","2024-06-27","2025-03-06","2023-03-22","2023-03-22","2023-03-21","2023-03-21","2023-03-21","2023-03-22","2023-03-22","2023-09-13","2023-07-12","2023-09-28","2023-10-24","2023-10-24","2023-10-24","2023-08-16","2025-07-28","2022-06-08","2022-06-08","2022-04-22","2022-04-08"],"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":[["","","TRULICITY","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","GEMTESA","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","FREESTYLE LIBRE 3 READER","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","XIAFLEX","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","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":""}]}]}