{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michael J Lester","gend":0,"currentgend":"","add":"16 PIN OAK DR 1","city":"SCARBOROUGH","state":"ME","zip":"04074","dob":"1957-09-10","age":"","mstatus":"","insh":"10000099250","cliId":"","pno":2077564230,"cno":"","email":"","ename":"","eno":"","pphy":"MEDD, DONALD J","ppno":2076621340,"pcpadd":"301 US ROUTE 1,BUILDING C","pcpcity":"SCARBOROUGH","pcpstate":"ME","pcpzip":"40749701","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"16 PIN OAK DR 1","madd2":"","madd3":"","mcity":"SCARBOROUGH","mstate":"ME","mzip":"04074","pcpfaxno":2073968632,"pcpnpi":1902810294,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6MN9DY7GY00","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E103313","H40033","H2513","Z13220","E1121","B20","M25561","M1712","E1122","N1831","Z794","R6889","I129","M1711","M170","R0602","Z0000","R262","N1832","R079","R059","J069","E6601"],"date":["2023-11-15","2023-11-15","2023-11-15","2025-04-12","2025-04-12","2025-04-15","2023-11-14","2024-01-12","2025-07-16","2025-04-15","2025-04-15","2023-11-15","2024-09-24","2023-12-14","2023-11-14","2025-02-16","2023-08-08","2023-08-08","2023-08-08","2025-02-15","2025-02-15","2025-02-15","2023-03-21"],"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":[["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","VALSARTAN","","","Select","Select",""],["","","TOUJEO SOLOSTAR","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","ULTRA-FINE MINI PEN NEEDLE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ULTRA-FINE PEN NEEDLE","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","DAPAGLIFLOZIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","DEXCOM G6 SENSOR","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","BIKTARVY","","","Select","Select",""],["","","VICTOZA 2-PAK","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","DEXCOM G6 RECEIVER","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","VICTOZA 3-PAK","","","Select","Select",""],["","","DEXCOM G6 TRANSMITTER","","","Select","Select",""],["","","VEO INSULIN SYRINGE","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","HUMALOG","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}