{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David R Normann","gend":0,"currentgend":"","add":"38 ADAMS ROAD","city":"FRANKFORT","state":"ME","zip":"04438","dob":"1951-08-04","age":"","mstatus":"","insh":"10000100557","cliId":"","pno":2075254456,"cno":"","email":"normanndr@gmail.com","ename":"","eno":"","pphy":"BOUCHARD, DENISE M","ppno":2073386900,"pcpadd":"PO BOX 1599,","pcpcity":"BANGOR","pcpstate":"ME","pcpzip":"44021599","pcpcounty":"","pcpid":"","pcpname":"SEAPORT COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"38 ADAMS ROAD","madd2":"","madd3":"","mcity":"FRANKFORT","mstate":"ME","mzip":"04438","pcpfaxno":2079470435,"pcpnpi":1467493023,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8PU6V42WR77","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M159","M19041","M1811","M7989","N400","Z8042","M67341","N401","M5450","H40013","L986","L821","S90861A","Z0101","H04123","H25813","K219","C4442","D485","Z0000","J0190","R42","M79674","M67472","K3532","K658","S30860A","R5383","R2689","H8309","R1013","Z79891","J029","K3580","K5730","E782","R81","R198","M2011","D044","M2021","M205X1","Z136","Z87891","R1031","N402","R9341","K30","Z23","M62830","M19042","K648","Z1211","R194","D2371","L820","R270","L570","L920"],"date":["2023-09-21","2024-01-19","2023-09-21","2023-09-21","2025-06-30","2025-06-30","2025-05-15","2025-07-14","2025-07-23","2025-04-25","2024-03-01","2024-03-01","2025-10-15","2025-04-25","2025-04-25","2025-04-25","2023-05-17","2025-03-20","2025-02-25","2024-07-31","2024-10-01","2024-09-09","2024-12-17","2024-04-11","2023-03-07","2023-03-07","2024-12-17","2024-12-17","2024-06-12","2024-06-12","2023-02-07","2023-03-29","2025-11-04","2023-03-07","2023-03-07","2025-08-06","2025-09-09","2024-05-28","2025-10-23","2025-02-25","2025-01-06","2025-01-06","2025-10-03","2025-10-03","2023-03-07","2023-03-07","2023-03-07","2023-03-07","2025-08-06","2024-03-15","2025-08-12","2024-03-05","2022-12-28","2023-07-11","2024-03-13","2025-04-11","2025-08-01","2024-03-01","2024-03-01"],"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":[["","","VALACYCLOVIR","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","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":""}]}]}