{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michael R Stuckmeyer","gend":0,"currentgend":"","add":"284 DANFORTH ST APT 506","city":"PORTLAND","state":"ME","zip":"04102","dob":"1958-04-16","age":"","mstatus":"","insh":"10000096716","cliId":"","pno":2074201991,"cno":"","email":"hvj4707017@yahoo.com","ename":"","eno":"","pphy":"OSULLIVAN, SEAN T","ppno":"","pcpadd":"76 High St Fl 1,","pcpcity":"Lewiston","pcpstate":"ME","pcpzip":"04240","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"284 DANFORTH ST APT 506","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04102","pcpfaxno":"","pcpnpi":1285073205,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9K52WY7HT80","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M86172","Z4781","Z89512","E1165","E11621","M869","Z22322","N179","I480","M79641","M79642","M549","H538","L97512","R262","E119","D649","R059","Z23","S30850A","X58XXXA","A409","J9601","R6521","R571","H35372","H43822","H33003","H2511","Z7985","F319","Z9151","R110","Z452","M795","Z87828","I10","E1159","L84","M79671","M79672","B351","M79674","M79675","A09","K635","H3342","F419","R58","Z0101","R197","R109","D509","L602","E1151","E1142","M2041","F4323","K449","E1140","Z794","E871","M19041","Z125","L97519","E11630","R1319","L089","L97429","F411","R4182","E11622","M86352","M14672","I517","J9691","R079","R066","Z0389","M1460","S91302A","R600","R1110","R160","L97423","Z8631","M179","A419","L97523","Z7984","S90822A","M7989","Z599","L97529","S91105A","L97421","M86372","E0840","Z5900"],"date":["2022-12-16","2023-06-14","2025-08-25","2025-07-20","2024-12-20","2022-12-14","2022-12-14","2022-12-14","2022-12-14","2023-06-15","2023-06-15","2024-04-14","2024-08-21","2024-12-20","2023-12-14","2025-05-08","2025-07-20","2024-04-14","2024-11-15","2024-05-01","2024-05-01","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2024-09-06","2024-09-06","2024-09-06","2024-09-06","2024-07-25","2024-07-25","2024-07-25","2023-05-05","2022-11-30","2023-08-31","2023-08-31","2024-09-10","2023-07-12","2023-07-12","2023-07-12","2023-07-12","2023-07-12","2023-07-12","2023-07-12","2025-07-24","2025-07-24","2024-05-07","2025-03-27","2024-04-17","2024-05-07","2025-07-24","2025-07-24","2023-07-17","2022-12-09","2024-09-10","2022-12-09","2024-12-20","2022-12-08","2023-08-09","2024-10-31","2024-10-31","2025-07-20","2024-09-10","2024-01-15","2024-10-16","2023-07-14","2023-08-09","2022-11-14","2022-11-17","2022-11-17","2022-11-17","2022-11-17","2022-11-17","2022-11-17","2022-11-14","2022-11-14","2022-11-13","2022-11-13","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-11-13","2022-11-13","2022-11-09","2022-11-09","2022-11-14","2022-11-14","2022-10-26","2022-10-26","2022-10-26","2022-11-17","2022-10-05","2022-10-19","2022-10-12","2022-09-27","2022-09-27","2022-09-27","2022-08-17"],"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":[["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","DEXCOM G6 SENSOR","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","ONETOUCH LANCETS","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","ULTRA-FINE SHORT PEN NEEDLE","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","DEXCOM G6 RECEIVER","","","Select","Select",""],["","","DEXCOM G6 TRANSMITTER","","","Select","Select",""],["","","ULTRA-FINE MINI PEN NEEDLE","","","Select","Select",""],["","","HUMATIN","","","Select","Select",""],["","","DEXCOM G7 RECEIVER","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","PROCTO-MED HC","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","INVOKANA","","","Select","Select",""],["","","ONETOUCH DELICA","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}