{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Terry Sawyer","gend":0,"currentgend":"","add":"416 CROSS RD","city":"BELFAST","state":"ME","zip":"04915","dob":"1957-01-12","age":"","mstatus":"","insh":"10000100226","cliId":"","pno":2073384436,"cno":2073235852,"email":"tsawyer57@hotmail.com","ename":"","eno":"","pphy":"KLEPACK, MARGARET","ppno":2075054567,"pcpadd":"11 CAPE JELLISON RD,","pcpcity":"STOCKTON SPRINGS","pcpstate":"ME","pcpzip":"49814349","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"416 CROSS RD","madd2":"","madd3":"","mcity":"BELFAST","mstate":"ME","mzip":"04915","pcpfaxno":2075054872,"pcpnpi":1447719471,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2R17K40VM49","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S2241XA","I252","N529","S91302A","E1149","E11621","Z043","J209","I2510","N1831","E113391","E113312","Z0000","Z23","E119","M25511","Z0100","E1159","L97521","S2249XA","N478","S91309D","I739","M19072","I7090","M7732","K029","R6889","E113212","M25531","E113492","E1140","N471","E538"],"date":["2024-06-18","2024-06-20","2023-03-10","2025-04-08","2025-07-31","2024-10-18","2024-06-17","2022-12-06","2024-06-11","2023-03-13","2025-10-31","2025-10-31","2024-08-29","2025-05-01","2024-12-02","2024-06-17","2025-10-16","2025-05-01","2024-10-04","2024-06-20","2023-01-26","2024-07-24","2025-01-23","2025-01-16","2025-01-16","2025-01-16","2023-06-06","2023-12-12","2025-10-16","2024-12-04","2024-10-08","2025-01-22","2022-10-18","2022-10-10"],"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":[["","","GLIPIZIDE ER","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","RYBELSUS","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","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":""}]}]}