{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rodney C Jacobs","gend":0,"currentgend":"","add":"18 BLACK POINT RD","city":"SCARBOROUGH","state":"ME","zip":"04074","dob":"1940-01-13","age":"","mstatus":"","insh":"10000102526","cliId":"","pno":2072454727,"cno":"","email":"coveside285@gmail.com","ename":"","eno":"","pphy":"EMERY, PETER","ppno":2077745816,"pcpadd":"100 FODEN RD WEST,STE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"4 JUNEBERRY LN","madd2":"","madd3":"","mcity":"SCARBOROUGH","mstate":"ME","mzip":"04074","pcpfaxno":2078741483,"pcpnpi":1649239765,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9JG6CU0YF60","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D120","Z1211","D122","D123","G309","I2510","F0150","F0280","M6281","R2689","E785","R790","Z23","F3289","F99","N1831","Z0000","I4891","F1099","R2241","R2681","M1990","F32A","M7989","I499","Z111","I129","F1010","S60512A","R600","I872","R0609","R079","R399","R195","M19042","M79642","M25561","E8342","S0993XA","S6992XA","S6991XA","H2511","H43813","H04123"],"date":["2024-08-15","2024-08-15","2024-08-15","2024-08-15","2025-08-25","2023-10-16","2025-02-25","2025-01-31","2025-07-23","2025-07-28","2025-02-24","2023-09-19","2025-09-05","2024-08-27","2023-12-14","2023-07-12","2025-02-24","2023-10-31","2023-04-19","2023-08-24","2025-07-28","2025-07-28","2023-04-19","2023-08-24","2023-08-23","2025-04-10","2025-02-24","2025-02-24","2025-05-17","2023-08-25","2023-08-25","2023-10-16","2023-10-16","2023-10-27","2023-10-27","2025-05-17","2025-05-17","2025-05-17","2025-03-17","2025-05-17","2025-05-17","2025-05-17","2023-10-25","2023-10-25","2023-10-25"],"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":[["","","MEMANTINE HCL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","ATENOLOL-CHLORTHALIDONE","","","Select","Select",""],["","","FUROSEMIDE","","","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":""}]}]}