{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Tony L Wood","gend":0,"currentgend":"","add":"280 CHICKEN MILL POND RD","city":"GOULDSBORO","state":"ME","zip":"04607","dob":"1957-10-21","age":"","mstatus":"","insh":"10000099910","cliId":"","pno":2074607315,"cno":"","email":"Tonylwood12@gmail.com","ename":"","eno":"","pphy":"MARLOWE FLANAGAN, LAURA","ppno":2076675899,"pcpadd":"Trenton Health Center,394 Bar Harbor Rd","pcpcity":"Trenton","pcpstate":"ME","pcpzip":"04605","pcpcounty":"","pcpid":"","pcpname":"TRENTON HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"280 CHICKEN MILL POND RD","madd2":"","madd3":"","mcity":"GOULDSBORO","mstate":"ME","mzip":"04607","pcpfaxno":2076647721,"pcpnpi":1790037620,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4FP7K19DP71","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","M47812","M50123","L570","M4802","M50122","N401","T1502XA","Z01818","L820","M5090","L578","L821","D1801","D485","M4722","M5136","M792","M542","R519","H918X3","Z98890","D239","N390","M5021","M4312","J029","F4542","J329","R030","L110","G5603","I771","G894","Z981","R1032","N50812","N329","M5416","M7918","Z20822","N3289","R399","N4289","Z792","N419","K5730","S0502XA","R1084","H9312","C44310","R059","Z0100","R102","M5030","Z0189","K9041","F419"],"date":["2024-11-11","2025-05-07","2024-01-05","2025-08-08","2025-07-08","2024-06-26","2025-07-25","2023-12-06","2025-03-07","2025-07-18","2024-04-08","2025-07-18","2025-07-18","2025-07-18","2025-07-18","2023-04-04","2023-02-06","2024-03-22","2024-02-15","2024-02-15","2025-02-07","2023-10-09","2024-03-15","2023-10-15","2025-03-07","2025-05-07","2024-01-21","2024-08-08","2023-07-28","2023-03-14","2024-03-15","2024-02-23","2023-10-20","2025-07-08","2023-04-04","2024-11-29","2024-04-01","2025-08-21","2025-01-17","2024-03-22","2024-01-21","2024-10-07","2025-04-16","2024-10-07","2024-10-07","2025-09-09","2024-11-29","2024-05-28","2024-03-01","2024-11-07","2024-01-17","2025-02-21","2024-01-26","2024-09-03","2022-10-05","2022-10-05","2025-07-21","2022-09-14"],"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":[["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","POLYMYXIN B SUL-TRIMETHOPRIM","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","SHINGRIX","","","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":""}]}]}