{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Stephen Reinhold","gend":0,"currentgend":"","add":"15 BRENTWOOD DR","city":"CUMBERLAND FORESIDE","state":"ME","zip":"04110","dob":"1948-12-27","age":"","mstatus":"","insh":"10000102707","cliId":"","pno":2078470600,"cno":"","email":"maxx87@twc.com","ename":"","eno":"","pphy":"CONNOLLY, MARY J","ppno":2078741489,"pcpadd":"100 FODEN RD WEST,SUITE 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":"15 BRENTWOOD DR","madd2":"","madd3":"","mcity":"CUMBERLAND FORESIDE","mstate":"ME","mzip":"04110","pcpfaxno":2078741483,"pcpnpi":1558535559,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7EE4UK1TA62","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5450","S76011D","M2560","M6281","M25552","M6790","S76012S","H93A3","E039","F3340","G4700","Z0001","H5213","H524","M9903","M19012","M5416","R053","M75112","L309","M24012","R29898","D125","Z86010","K621","H6122","H903","M48062","M76892","J069","M5136","M47816","M4186","Z23","H6983","H9313","R052","U071","M48061","M47817","M4316","H43813","M1612","R682","R1310","Z0000","Z125","H04123","H01003","H01006","L719","M1A9XX0","M25512","M65332","N401","M25511","M25469","R6889","S76312A","H6123","H40053","M79645","R197","H9193","R21","H538","L298","D235","Z13220","R9720","L281","R631"],"date":["2024-09-20","2023-02-24","2023-10-24","2024-06-18","2024-08-01","2024-06-18","2023-01-05","2023-07-11","2025-10-15","2023-06-29","2023-06-29","2025-10-24","2025-09-24","2025-09-24","2024-02-29","2025-03-24","2025-02-26","2025-11-05","2024-04-06","2024-08-16","2024-04-22","2024-04-06","2023-07-14","2023-07-14","2023-07-14","2025-10-24","2025-04-17","2025-02-26","2023-10-24","2023-10-18","2024-09-13","2024-09-13","2024-02-29","2025-09-08","2023-03-14","2025-04-17","2023-03-14","2023-03-14","2024-11-27","2024-09-20","2024-10-31","2025-07-15","2024-08-20","2025-11-05","2025-11-05","2024-07-02","2024-07-02","2024-07-15","2023-07-07","2023-07-07","2024-07-15","2023-08-18","2024-06-06","2023-11-22","2023-03-31","2025-04-30","2025-04-30","2025-04-30","2024-08-11","2023-04-21","2024-07-15","2023-01-13","2024-01-15","2023-07-11","2024-05-28","2025-03-14","2024-05-28","2024-05-28","2025-10-15","2025-10-15","2024-04-30","2025-11-03"],"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":[["","","TERAZOSIN HCL","","","Select","Select",""],["","","DESVENLAFAXINE SUCCINATE ER","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","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":""}]}]}