{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Leslie W Tait","gend":0,"currentgend":"","add":"48 BLUEBERRY LN","city":"GRAY","state":"ME","zip":"04039","dob":"1951-07-16","age":"","mstatus":"","insh":"10000097411","cliId":"","pno":2075726381,"cno":"","email":"declined@072723.com","ename":"","eno":"","pphy":"MICHAELIS, TODD M","ppno":2078741489,"pcpadd":"InterMed,100 Foden Rd Ste 203","pcpcity":"South Portland","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"48 BLUEBERRY LN","madd2":"","madd3":"","mcity":"GRAY","mstate":"ME","mzip":"04039","pcpfaxno":2075238590,"pcpnpi":1649565672,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6N02DQ3XX27","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E162","S199XXA","S299XXA","S3992XA","S0990XA","E119","E1122","Z0000","M1A09X0","D649","I129","E785","E1169","J449","F0390","E11649","G309","F0280","R197","R634","F03B0","N1832","R413","R531","R52","F03911","N184","I10","Z23","H2512","A000","R1310","H2511","N179","F4323","H2513","D509","E878","R6889","M25561","G301","F02B0","N189","R059","L568","K219","J441","I499","Z5189","E875","E870","N1831","S80211A","R053","R4182","Z86010","I151","D123","R627","E1165","R6330","K648","H43393","J439","H31093","R5381","Z008","R918","Z0279","Z5989","R1312","E1159","S9421XD","S9421XA","E1129","M21371","R351"],"date":["2025-06-19","2025-06-12","2024-10-24","2024-10-24","2025-06-12","2024-10-25","2024-11-30","2023-01-06","2024-10-17","2024-10-26","2025-03-06","2024-10-17","2025-10-24","2025-10-24","2025-10-24","2025-06-19","2025-02-25","2025-02-25","2025-11-12","2023-11-02","2024-07-25","2023-10-19","2024-05-21","2025-06-26","2025-06-26","2025-09-04","2025-11-13","2025-09-04","2024-09-24","2024-09-12","2025-04-01","2024-01-25","2024-08-22","2025-06-27","2024-05-21","2024-07-17","2025-09-25","2025-08-12","2023-08-14","2025-06-12","2024-10-25","2024-10-25","2025-06-13","2023-11-02","2024-04-03","2024-08-22","2023-03-22","2025-07-30","2023-02-24","2025-06-27","2025-06-27","2023-09-21","2025-06-12","2023-01-06","2025-07-01","2024-01-25","2023-09-21","2024-01-25","2025-06-30","2025-10-14","2023-02-24","2024-01-25","2024-04-09","2023-11-02","2024-04-09","2025-06-30","2025-02-04","2023-11-02","2025-06-30","2025-06-30","2023-01-06","2023-01-06","2022-10-28","2022-09-14","2022-07-01","2022-07-01","2022-07-01"],"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":[["","","FAMOTIDINE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FLUOXETINE HCL","","","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":""}]}]}