{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Brian E Ames","gend":0,"currentgend":"","add":"139 OLD SHEEPSCOT RD","city":"WISCASSET","state":"ME","zip":"04578","dob":"1957-03-16","age":"","mstatus":"","insh":"10000101574","cliId":"","pno":2073738133,"cno":"","email":"","ename":"","eno":"","pphy":"YEH, LISA J","ppno":"","pcpadd":"108 CENTRE ST,","pcpcity":"BATH","pcpstate":"ME","pcpzip":"45302550","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"139 OLD SHEEPSCOT RD","madd2":"","madd3":"","mcity":"WISCASSET","mstate":"ME","mzip":"04578","pcpfaxno":2073861801,"pcpnpi":1043622012,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2W77C22HN75","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11622","L97212","L88","I872","I10","E7849","L97912","I87311","L97812","R600","E1165","S81802D","L97822","E119","E785","I83019","A000","L97922","Z6834","I87332","L97229","L409","Z0000","S81801D","E1122","L97829","R239","L97828","L97818","L859","L97228","L309","I480","E118","I83028","I130","I5032","R262"],"date":["2024-04-15","2024-02-27","2025-11-05","2024-05-14","2024-04-15","2023-10-11","2024-04-09","2023-05-09","2024-03-05","2023-10-24","2025-10-23","2023-08-22","2023-03-28","2023-03-29","2024-06-20","2025-10-02","2023-01-06","2023-03-07","2024-01-09","2023-06-26","2023-06-26","2025-10-23","2025-07-23","2024-05-14","2023-05-11","2023-01-17","2023-01-03","2023-04-11","2023-04-11","2025-09-04","2023-06-20","2023-04-18","2024-02-14","2023-02-22","2023-06-20","2023-05-11","2023-05-11","2023-05-11"],"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":[["","","OZEMPIC","","","Select","Select",""],["","","HALOBETASOL PROPIONATE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","FAMOTIDINE","","","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":""}]}]}