{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mark D Young","gend":0,"currentgend":"","add":"60 MARSH RD","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1960-10-11","age":"","mstatus":"","insh":"10000098870","cliId":"","pno":2073299342,"cno":2076716395,"email":"DECLINED@06262025.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":"60 MARSH RD","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":2075238590,"pcpnpi":1649565672,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1D39VK6FY21","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R404","J322","G629","M5451","D013","K648","R200","R030","M47817","D72810","M5450","M546","M2560","M5416","I10","E785","Z0001","Z125","M5134","M47814","M5116","M4726","M4316","R1032","R070","M5440","R42","G4489","R1013","R1012","K148","R2689","M4804","M9903","M9904","M9905","M5414","R202","M48061","R234","K219","F1190","K5900","F419","M79603","M79606","M50321","M47812","K6282","M9902","R0781","G8929","Z79891","D649","A630","R109","R6889","D72819","K5730","Z86010","T1502XA","Z0101","H16223","H2513","F411","M542","K2960","L989","M25551","I70212","M1611","G609","K5909","M9901","R0989","K1379","F325","E7800","Z1389","R634","A049","R140"],"date":["2024-10-30","2024-10-30","2025-07-31","2025-08-28","2025-11-04","2025-11-04","2024-10-31","2024-10-30","2025-01-20","2025-04-02","2025-06-25","2025-06-25","2023-01-24","2025-04-01","2025-11-04","2025-09-23","2025-03-05","2025-03-05","2023-02-22","2023-04-06","2023-02-22","2023-02-22","2023-02-22","2024-05-20","2024-06-06","2023-02-22","2024-10-31","2024-03-06","2023-01-30","2023-01-30","2023-08-29","2024-02-26","2023-12-04","2025-08-28","2025-08-28","2025-08-28","2023-12-04","2025-10-15","2023-11-07","2023-08-22","2025-11-04","2025-11-04","2025-07-31","2025-07-31","2025-07-21","2025-07-21","2024-11-07","2024-11-25","2025-09-23","2025-06-25","2023-04-06","2025-09-23","2023-06-05","2024-07-30","2024-06-12","2024-06-12","2023-01-26","2024-09-10","2024-09-19","2024-09-19","2025-05-07","2025-03-11","2025-03-11","2025-03-11","2024-11-07","2024-11-07","2024-05-14","2024-07-25","2022-12-15","2025-10-07","2022-12-15","2025-10-07","2025-06-04","2025-06-09","2023-08-25","2023-08-22","2022-12-15","2025-06-05","2022-10-13","2022-10-18","2022-10-18","2022-10-18"],"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":[["","","METHADONE HCL","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","IRBESARTAN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","TOBRAMYCIN-DEXAMETHASONE","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ADACEL TDAP","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUGMENTED","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","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":""}]}]}