{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mark A Doty","gend":0,"currentgend":"","add":"1236 EAST MADISON RD","city":"MADISON","state":"ME","zip":"04950","dob":"1957-08-31","age":"","mstatus":"","insh":"10000098822","cliId":"","pno":2076121174,"cno":"","email":"","ename":"","eno":"","pphy":"Lambke, Michael H","ppno":2074746201,"pcpadd":"SKOWHEGAN FAMILY MEDICINE,46 FAIRVIEW AVE STE 334","pcpcity":"SKOWHEGAN","pcpstate":"ME","pcpzip":"04976","pcpcounty":"","pcpid":"","pcpname":"SKOWHEGAN FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1236 EAST MADISON RD","madd2":"","madd3":"","mcity":"MADISON","mstate":"ME","mzip":"04950","pcpfaxno":2074740969,"pcpnpi":1134126428,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1XY6AT6PE71","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T7849XA","D225","D229","L814","L821","Z139","L570","C8590","R197","Z125","Z1211","C44622","N410","N411","N400","K5900","K7689","R9341","D492","Z0101","Z0000","Z79899","N401","H903","R39198","H5213","H524","H52203","Z09","Z20822","Z96611","R3911","Z471","R6889","L089","Z0100","T8189XA","D239","Z01818"],"date":["2025-03-18","2025-05-07","2025-05-07","2025-05-07","2025-05-07","2024-08-01","2025-05-07","2022-12-30","2023-03-29","2022-11-10","2023-01-10","2025-03-07","2025-06-10","2025-06-10","2025-06-10","2022-12-30","2022-12-30","2022-12-30","2023-08-15","2022-12-21","2024-11-19","2025-06-10","2025-02-21","2025-05-06","2024-06-27","2024-01-02","2024-01-02","2024-01-02","2022-12-21","2023-01-07","2022-12-21","2024-10-25","2022-08-03","2023-10-25","2024-01-02","2025-06-10","2025-05-23","2024-02-15","2025-05-12"],"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":[["","","TAMSULOSIN HCL","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","CICLOPIROX","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","PAXLOVID (EUA)","","","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":""}]}]}