{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Thomas L Sukley","gend":0,"currentgend":"","add":"19 WILDRIDGE RD","city":"STANDISH","state":"ME","zip":"04084","dob":"1957-05-17","age":"","mstatus":"","insh":"10000096723","cliId":"","pno":2074688873,"cno":"","email":"TKSUKLEY@ROADRUNNER.COM","ename":"","eno":"","pphy":"CLARK, DAVID E","ppno":2078343155,"pcpadd":"NMMC Medical Practices,194 E Main St Fl 1","pcpcity":"Fort Kent","pcpstate":"ME","pcpzip":"04743","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"19 WILDRIDGE RD","madd2":"","madd3":"","mcity":"STANDISH","mstate":"ME","mzip":"04084","pcpfaxno":"","pcpnpi":1760910863,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9GJ0R04UA26","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D122","Z860101","K5730","D0422","M25562","W57XXXA","R6889","S40861A","F900","M25572","S61419A","S2096XA","R059","R0982","J4520","J309","Z471","L570","Z0000","Z23","H5711","H40052","H11001","H2513","Z96652","H40053","H3589","K635","L308","D235","D2271","E782","R002","S99912A","L304","Q6630","Z96659","G8929","D492","D0462","L439","M19072","C4441","N401","M1A00X0","Z889","Z0001","J40","H9202","S0501XD","M25672","Z8249","L918","R208","M79609","E669","Z6838","L821","L820","J45909","R052","J320","Z6836","L578","U071","A000","Z20822","M1712","G8918","I10","E785","M21162","M25462","M170","Z125","Z01810"],"date":["2024-12-10","2024-12-10","2024-12-10","2024-05-23","2024-02-08","2024-08-14","2023-04-18","2024-08-14","2024-11-20","2024-06-07","2024-08-10","2024-08-10","2022-12-16","2022-12-16","2023-12-20","2022-12-16","2024-02-08","2025-09-23","2024-02-26","2023-11-01","2023-03-08","2023-12-11","2023-06-14","2025-06-24","2023-06-08","2025-06-24","2025-06-24","2024-12-10","2024-02-20","2023-10-05","2023-10-05","2025-05-23","2023-11-09","2024-06-07","2023-10-05","2023-06-30","2023-06-30","2023-06-30","2025-09-23","2024-05-13","2024-02-20","2023-06-30","2025-06-03","2025-05-23","2025-05-23","2023-11-01","2025-05-28","2023-12-20","2025-06-21","2023-06-14","2023-06-08","2023-11-09","2023-06-08","2023-06-08","2023-06-08","2025-08-19","2025-08-19","2025-09-23","2024-05-13","2022-10-31","2022-10-18","2022-10-18","2022-10-18","2022-10-06","2022-08-12","2022-05-17","2022-05-14","2022-05-16","2022-05-16","2022-05-16","2022-05-16","2022-05-16","2022-05-27","2022-05-12","2022-05-06","2022-05-06"],"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",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}