{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Paul Morin","gend":0,"currentgend":"","add":"91 WARDTOWN RD","city":"FREEPORT","state":"ME","zip":"04032","dob":"1958-07-11","age":"","mstatus":"","insh":"10000099347","cliId":"","pno":2073146232,"cno":"","email":"Paulmorin76@gmail.com","ename":"","eno":"","pphy":"KNIGHTON, BRIAN K","ppno":2078653491,"pcpadd":"42 MALLETT DRIVE,","pcpcity":"FREEPORT","pcpstate":"ME","pcpzip":"40326760","pcpcounty":"","pcpid":"","pcpname":"FREEPORT MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"91 WARDTOWN RD","madd2":"","madd3":"","mcity":"FREEPORT","mstate":"ME","mzip":"04032","pcpfaxno":"","pcpnpi":1700824000,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1H01M73VA09","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K029","M87180","K006","C01","I499","Z5112","M272","R070","R0600","Z86718","R918","C108","Z5111","G529","J0190","M542","R1310","E7849","C7989","C760","Z08","Z85810","Z923","L598","C801","J690","K2289","C140","Z931","C109","Y842","Z125","Z9221","C4492","Z79899","Z452","Z23","Z0000","Z1211","I898","G893","E860","Z0001","R9720","K2090","R6884","R110","J189","Z85818","K219","R4182","K111","M47812","R059","Z95828","E786","D6481","M26629","J939","R0602","Z4682","H5213","H25813"],"date":["2023-07-27","2023-07-27","2023-07-27","2025-10-07","2025-10-13","2025-10-07","2023-08-11","2025-02-06","2025-10-13","2025-10-13","2025-10-13","2025-10-13","2025-07-15","2025-02-03","2024-05-01","2024-09-24","2025-07-23","2024-09-30","2025-09-10","2025-09-10","2023-04-05","2023-04-05","2024-02-28","2023-07-21","2025-03-14","2025-10-13","2024-10-24","2025-07-23","2025-07-23","2025-03-14","2023-07-21","2024-04-09","2024-02-28","2024-02-23","2025-09-16","2023-06-21","2024-09-30","2024-09-30","2023-10-10","2024-07-06","2025-08-14","2025-09-02","2025-10-24","2024-04-09","2024-10-24","2023-08-25","2025-05-09","2025-10-13","2025-10-13","2025-02-06","2025-02-06","2025-03-14","2025-03-14","2025-04-07","2025-03-02","2023-09-22","2025-05-05","2024-07-06","2025-10-13","2025-10-13","2025-10-13","2024-07-10","2024-07-10"],"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",""],["","","OXYCONTIN","","","Select","Select",""],["","","FENTANYL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","SCOPOLAMINE","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","MORPHINE SULFATE","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","GLYCOPYRROLATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CARBAMAZEPINE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","FLUZONE QUAD 2022-2023","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)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":""}]}]}