{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gerald F Rodman","gend":0,"currentgend":"","add":"65 UPPER POND RD","city":"LITCHFIELD","state":"ME","zip":"04350","dob":"1945-01-27","age":"","mstatus":"","insh":"10000102795","cliId":"","pno":2074852129,"cno":"","email":"grodman1@icloud.com","ename":"","eno":"","pphy":"SCHIFF SLATER, SCOTT D","ppno":2076260606,"pcpadd":"Hallowell Family Practice,\t9 Union St","pcpcity":"Hallowell","pcpstate":"ME","pcpzip":"04347","pcpcounty":"","pcpid":"","pcpname":"HALLOWELL FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 1129","madd2":"","madd3":"","mcity":"Patagonia","mstate":"AZ","mzip":"85624","pcpfaxno":2076260022,"pcpnpi":1750354957,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7DG4G53WP84","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R55","R1111","L570","K589","G4700","Z8679","Z23","E785","D709","H25813","H5703","R918","Z136","R5383","H35373","H209","H43391","H43813","H2513","H40023","Z961","J159","Z20822","I2584","H25811","I7140","J189","Z125","R051","R6889","Z1331","R059","S0501XA","J9811","J181","R110","B6000","A6920","D696","U071","R042","Z0001","H25812"],"date":["2025-07-08","2025-07-08","2023-06-12","2023-06-12","2023-06-12","2023-06-12","2025-10-23","2025-10-08","2025-10-08","2025-04-23","2025-07-08","2025-04-22","2025-04-22","2024-11-11","2025-10-24","2025-10-24","2025-10-24","2025-10-24","2023-04-25","2023-04-25","2025-08-26","2024-09-11","2023-10-23","2025-04-22","2025-07-08","2025-04-22","2024-01-22","2025-07-29","2023-11-07","2023-08-25","2024-02-12","2024-02-12","2025-10-03","2024-01-22","2023-11-16","2025-07-08","2023-05-15","2023-05-15","2023-05-15","2024-01-05","2023-12-29","2025-10-23","2025-07-15"],"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":[["","","ERYTHROMYCIN","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","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":""}]}]}