{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Thomas K Higley","gend":0,"currentgend":"","add":"5 MAIN ST","city":"MOUNT VERNON","state":"ME","zip":"04352","dob":"1954-08-15","age":"","mstatus":"","insh":"10000103117","cliId":"","pno":3035708888,"cno":"","email":"tom@tomhigley.com","ename":"","eno":"","pphy":"BROWN, BENJAMIN M","ppno":2073772111,"pcpadd":"Winthrop Family Medicine,16 Commerce Plaza Ste 3A","pcpcity":"Winthrop","pcpstate":"ME","pcpzip":"04364","pcpcounty":"","pcpid":"","pcpname":"WINTHROP FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5 MAIN ST","madd2":"","madd3":"","mcity":"MOUNT VERNON","mstate":"ME","mzip":"04352","pcpfaxno":2076243845,"pcpnpi":1235216094,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5T88VP2WP10","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5116","M48061","M5417","M439","M5137","M5117","M4807","Z1211","Z1212","I77810","N3289","N390","Z0101","G8929","I7121","C678","C679","R399","Z87891","M5187","G4730","R200","I10","N329","D494","Z8551","Z0001","M5416","M4727","M4726","M4724","Z23","M5126","M47816","E785","R0789","N4400","K5730","R319","R197","M5441","M67442","Z136","M5136","S90562A","L03116","Z483","N3000","Z0000","R3915","Z466","R82998","U071","Z01818"],"date":["2023-06-07","2023-06-07","2023-03-01","2022-12-16","2022-12-16","2023-02-05","2023-03-01","2025-02-27","2025-02-27","2025-01-16","2025-07-23","2025-11-07","2025-01-24","2023-03-15","2025-01-13","2025-09-09","2025-11-05","2025-10-20","2025-09-09","2023-03-15","2023-06-07","2023-01-31","2025-09-09","2025-07-31","2025-07-15","2025-11-12","2025-02-04","2023-06-07","2022-12-16","2022-12-16","2022-12-16","2024-10-11","2023-06-07","2023-03-02","2025-03-24","2024-10-29","2025-07-03","2025-07-03","2025-07-03","2025-05-29","2024-04-11","2025-04-28","2025-04-07","2023-05-05","2024-03-19","2024-03-19","2025-09-09","2025-08-25","2024-02-01","2025-09-09","2025-08-04","2025-06-26","2023-09-18","2025-08-13"],"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":[["","","AMPICILLIN TRIHYDRATE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","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":""}]}]}