{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David R Dubois","gend":0,"currentgend":"","add":"14 FAIRWOOD CIR","city":"HOLLIS CENTER","state":"ME","zip":"04042","dob":"1956-02-29","age":"","mstatus":"","insh":"10000099177","cliId":"","pno":2078386405,"cno":"","email":"dubois7043@roadrunner.com","ename":"","eno":"","pphy":"GALBRAITH, DAVID W","ppno":2077939586,"pcpadd":"44 ELM ST,","pcpcity":"LIMERICK","pcpstate":"ME","pcpzip":"40483924","pcpcounty":"","pcpid":"","pcpname":"GALBRAITH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"14 FAIRWOOD CIR","madd2":"","madd3":"","mcity":"HOLLIS CENTER","mstate":"ME","mzip":"04042","pcpfaxno":2077939587,"pcpnpi":1609836238,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2PX8XK0HX25","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z87891","S61211D","S61213D","S62635D","S61217D","E782","Z7689","Z6826","Z125","R799","R946","Z131","Z23","Z0000","Z136","I700","R6889","Z0101","S62633D","M25632","M25642","M79645","M6281","S6292XA","S66123A","S61211A","S61217A","S62615A","S62635A","S61213A","S61215A","S62633A","Z6827","S6992XA","S62633B","S62635B","S61402A","W298XXA","S61215D","S66123D","S62615D","S62613D","S66125D"],"date":["2024-01-05","2023-07-31","2023-07-17","2023-06-26","2023-07-31","2025-06-12","2023-10-12","2023-11-15","2024-11-08","2023-10-12","2023-10-12","2024-11-08","2024-11-20","2024-11-20","2024-01-05","2024-01-05","2023-01-17","2024-09-12","2023-07-31","2023-08-14","2023-08-14","2023-08-14","2023-08-14","2023-05-03","2023-05-03","2023-05-03","2023-05-03","2023-05-03","2023-05-03","2023-04-26","2023-04-25","2023-04-26","2024-11-20","2023-04-25","2023-04-25","2023-04-25","2023-04-25","2023-04-25","2023-07-17","2023-07-31","2023-06-15","2023-06-15","2023-07-17"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}