{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert J Sproul","gend":0,"currentgend":"","add":"63 FIFTH ST APT 3","city":"AUBURN","state":"ME","zip":"04210","dob":"1957-11-25","age":"","mstatus":"","insh":"10000101894","cliId":"","pno":2074400340,"cno":"","email":"","ename":"","eno":"","pphy":"FAGONE, RENEE S","ppno":2077955700,"pcpadd":"12 HIGH ST,SUITE 400","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407676","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"63 FIFTH ST APT 3","madd2":"","madd3":"","mcity":"AUBURN","mstate":"ME","mzip":"04210","pcpfaxno":2077955727,"pcpnpi":1164653879,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2J70WT1YJ23","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I824Y2","R0781","K5900","K56609","I871","I82402","Z23","M7989","K436","K449","R2242","K649","M6281","I82412","M79604","Z48812","M79605","I82432","R238","S0001XA","X58XXXA","F319","R55","K6389","R600","I739","K439","Z98890","L03116","Z7901","Z20822","J984","R0902","R109","D649","E039","Z0000","L03115","I82409","D500","D509","G4700","Z9109","I499","R262","R2241","N400","Z538","R1084","K432","I82419","I82502","K922","R059","K047","T454X5A","K089","K460"],"date":["2023-05-26","2025-02-27","2023-04-05","2025-04-16","2025-02-27","2025-02-27","2023-04-06","2025-02-20","2023-04-18","2025-04-16","2025-09-07","2023-04-23","2023-04-01","2023-03-31","2025-08-27","2023-03-28","2023-03-28","2023-03-28","2023-02-28","2023-02-28","2023-02-28","2025-02-27","2023-10-06","2023-03-26","2023-07-14","2023-07-14","2025-09-07","2023-04-04","2025-01-19","2023-09-15","2023-03-19","2023-03-22","2023-03-22","2023-03-19","2025-09-11","2023-04-25","2025-08-27","2025-09-11","2025-09-11","2023-10-06","2023-04-21","2023-04-21","2023-04-21","2023-03-24","2023-04-25","2025-08-27","2023-04-25","2023-10-06","2023-03-19","2025-05-13","2023-05-15","2023-09-15","2023-09-15","2025-09-07","2023-01-15","2023-10-06","2023-04-11","2023-04-04"],"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":[["","","FUROSEMIDE","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","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":""}]}]}