{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Roger E Gagnon","gend":0,"currentgend":"","add":"5 BOG RD","city":"Benton","state":"ME","zip":"04901","dob":"1949-02-19","age":"","mstatus":"","insh":"10000097109","cliId":"","pno":2074536775,"cno":"","email":"declined@100224.com","ename":"","eno":"","pphy":"BARTHOLOMEW, STEPHANIE G","ppno":2074533100,"pcpadd":"4 SHERIDAN RD,","pcpcity":"FAIRFIELD","pcpstate":"ME","pcpzip":"49373314","pcpcounty":"","pcpid":"","pcpname":"FOUR SEASONS FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5 BOG RD","madd2":"","madd3":"","mcity":"Benton","mstate":"ME","mzip":"04901","pcpfaxno":2078615082,"pcpnpi":1033185988,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1NU8F75CG39","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1142","I10","R42","G43909","N400","F418","R350","Z23","G4730","G4761","G4733","G9340","D225","L814","L821","Z08","I480","G4710","I4891","I4892","S0083XA","S20211A","R29898","G319","R410","Z7984","S0990XA","I6782","H25812","E041","S3991XA","S3993XA","S199XXA","S299XXA","R55","R531","E119","H26493","H43813","H2513","Z0000","R4182","H903","H9311","S0003XA","H25811","H9193","E785","I499","H9190","J300","J342","I358","I6523","R4781","E7849","H900","I2510","Z0389","R079","W19XXXD","Z0279","Z8669","S41111A","S41112A","R112","Z87891"],"date":["2025-03-28","2025-07-23","2025-07-17","2023-03-13","2025-04-17","2025-04-17","2025-04-17","2023-10-23","2023-12-27","2023-12-27","2023-09-19","2025-07-25","2025-06-03","2025-06-03","2025-06-03","2025-06-03","2024-11-15","2023-09-12","2025-05-16","2023-09-12","2024-12-21","2024-12-21","2025-04-27","2025-04-27","2025-07-23","2023-10-19","2024-12-21","2024-12-21","2024-01-29","2025-07-17","2024-12-21","2024-12-21","2024-12-21","2024-12-21","2023-10-10","2025-04-27","2025-10-02","2025-03-11","2025-03-11","2023-09-29","2025-06-05","2025-07-23","2023-07-07","2023-04-13","2024-12-21","2024-02-12","2023-07-11","2024-11-08","2025-07-27","2023-03-23","2023-03-23","2023-03-23","2023-11-01","2025-07-17","2025-07-17","2023-09-19","2023-09-19","2024-11-08","2024-12-26","2025-04-27","2024-12-24","2023-05-09","2023-05-09","2025-07-23","2025-07-23","2025-07-23","2022-09-30"],"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":[["","","METFORMIN HCL","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","VASCEPA","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","NITROGLYCERIN","","","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":{"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":""}]}]}