{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Thomas J Anderson","gend":0,"currentgend":"","add":"46 HIGH ST","city":"Houlton","state":"ME","zip":"04730","dob":"1950-07-09","age":"","mstatus":"","insh":"10000096986","cliId":"","pno":2075386450,"cno":"","email":"lollydog1@gmail.com","ename":"","eno":"","pphy":"BLAND, LEE G","ppno":2075324068,"pcpadd":"Sigrid E Tompkins Health Center,22 Hartford St","pcpcity":"Houlton","pcpstate":"ME","pcpzip":"04730","pcpcounty":"","pcpid":"","pcpname":"HOULTON FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"46 HIGH ST","madd2":"","madd3":"","mcity":"Houlton","mstate":"ME","mzip":"04730","pcpfaxno":2075329426,"pcpnpi":1831284918,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8U05YQ5VR62","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L570","Z85828","D045","R6889","L821","L920","M47897","H6591","H401132","H353131","H43813","H26493","C4491","R159","M25552","H401130","H353132","Z0000","E278","M9901","M542","M9902","M62830","H6121","R21","Z0101","H524","E049","E0789","D3502","H6122","E673","E785","M7050","R232","R634","F5101","B019","Z87891"],"date":["2025-09-12","2024-08-20","2023-07-12","2022-11-07","2025-09-12","2024-08-20","2024-08-20","2025-07-12","2023-10-26","2023-10-26","2024-12-23","2024-12-23","2025-09-12","2024-07-11","2024-05-03","2024-12-23","2024-12-23","2025-08-15","2024-07-12","2024-07-11","2024-07-11","2024-07-11","2024-07-11","2024-06-26","2023-04-28","2024-11-08","2024-11-08","2022-12-22","2022-11-04","2025-07-14","2024-08-14","2025-07-11","2024-07-02","2022-09-14","2022-09-14","2022-08-04","2022-07-22","2022-07-07","2022-07-07"],"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":[["","","DEXAMETHASONE","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","SHINGRIX","","","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":[]}},{"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":""}]}]}