{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John E Shannon","gend":0,"currentgend":"","add":"14 PEARL ST","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1957-10-23","age":"","mstatus":"","insh":"10000099685","cliId":"","pno":2073326734,"cno":"","email":"Jsha601180@aol.com","ename":"","eno":"","pphy":"BARR, DOUGLAS","ppno":2077745816,"pcpadd":"100 FODEN RD WEST,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":"14 PEARL ST","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":2078741483,"pcpnpi":1134180359,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3VT7DW7HN53","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5416","R269","M79602","I2510","I10","G4731","G4733","E1065","R1111","E7800","Z23","E1059","E103393","E1036","H401134","E109","Z794","R140","R0602","R053","Z87891","K3189","K449","M5450","M2560","M62838","M955","Z122","Z0001","L570","Z7189","Z0100","H35351","R0601","M4726","H2511","G4737","R0609","Z136","H2513","H04123","Z125","R052","M47816","I5189","R079","M25551","M25552","I501","M48061","M5117","M4727","M4316","M5442","E103293","M4125","I4720","G4730","R0683","R5382","S2241XA","S299XXA","Z0101","I6782","Z9641","R0789","E10319","N529"],"date":["2024-08-09","2023-02-13","2023-02-13","2025-11-04","2025-11-04","2025-10-30","2025-10-30","2025-10-16","2024-09-30","2025-11-04","2024-09-12","2024-12-09","2024-12-09","2024-12-09","2025-08-19","2025-09-29","2025-09-29","2025-01-08","2025-01-08","2025-01-08","2025-02-17","2024-09-30","2024-09-30","2023-09-28","2023-09-28","2023-09-28","2023-09-28","2025-02-17","2025-07-30","2024-07-25","2024-07-25","2025-02-12","2025-11-12","2024-11-08","2023-08-02","2025-07-16","2025-10-06","2025-05-06","2024-08-19","2025-06-20","2025-06-20","2025-07-30","2024-11-08","2024-02-22","2024-10-08","2023-02-12","2023-12-18","2023-12-18","2025-10-06","2024-01-24","2024-01-24","2024-01-24","2024-01-24","2024-01-24","2023-07-20","2024-03-13","2023-02-15","2025-02-22","2025-02-22","2025-02-22","2023-04-29","2023-04-29","2024-02-27","2023-02-13","2022-12-05","2023-04-29","2023-04-29","2022-11-10"],"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":[["","","TRESIBA FLEXTOUCH U-100","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","TRESIBA","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","NOVOLOG","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","TIOTROPIUM BROMIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","DEXCOM G6 SENSOR","","","Select","Select",""],["","","DEXCOM G6 TRANSMITTER","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","INSULIN SYRINGE","","","Select","Select",""],["","","SURE COMFORT","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","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":{"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}