{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John R King","gend":0,"currentgend":"","add":"99 SKYLARK RD","city":"PORTLAND","state":"ME","zip":"04103","dob":"1945-05-22","age":"","mstatus":"","insh":"10000103719","cliId":"","pno":2079561697,"cno":2079392741,"email":"johnraymondking@gmail.com","ename":"","eno":"","pphy":"DOBIESKI, STEVEN T","ppno":2077745816,"pcpadd":"InterMed,84 Marginal Way Ste 800","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"99 SKYLARK RD","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":2078741483,"pcpnpi":1942279617,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7DR7NV5KE35","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M48061","G4733","M5116","M4316","M9903","M9901","M9905","M9902","Z0001","G5603","H2512","G4730","E669","F32A","Z0000","M5416","M5450","M2560","M6281","M62838","Z1211","R109","D120","Z860101","K5730","M5441","M47816","G8929","H2511","S61452A","M4726","I10","F331","M792","H04123","M5489","M4125","M546","M7918","I2510","R7303","E785","R030","N3941","M5136","M25571","I499","L570","L219","L578","M25561","Z85828","L821","Z23","M25462","R42","S8392XA","B070","I7389","L602","M79674","M79675","H903","M79671","M79672","L84","H02831","H02834","H57813","M1712","M25562","M1711","Z961","M1611","M461","M4156","H2513","L218","L814","G5601","M19071","M7661","M160","D485","Z0101","H25013","H5203"],"date":["2025-10-15","2025-11-04","2025-04-28","2025-04-28","2024-10-24","2024-10-24","2024-10-24","2024-10-24","2025-02-14","2025-05-15","2023-08-03","2023-07-13","2023-07-13","2023-07-13","2024-02-13","2025-10-06","2025-08-19","2023-10-03","2023-10-03","2023-10-03","2025-05-27","2024-05-14","2025-05-27","2025-05-27","2025-05-27","2025-04-28","2025-09-18","2025-11-05","2023-08-03","2025-03-18","2023-09-11","2024-05-14","2025-08-05","2023-09-21","2025-05-30","2025-03-07","2025-03-07","2025-05-17","2025-05-17","2025-02-17","2025-02-17","2025-02-17","2024-02-13","2025-02-17","2024-09-30","2024-08-27","2025-08-19","2025-09-03","2025-04-09","2025-09-03","2025-11-05","2023-12-01","2025-09-03","2025-11-11","2023-12-26","2023-04-12","2023-12-24","2025-08-12","2025-08-12","2025-08-12","2025-08-12","2025-08-12","2024-06-19","2025-08-05","2025-08-05","2025-08-05","2025-02-19","2025-02-19","2025-02-19","2023-12-24","2023-12-24","2025-11-05","2023-11-01","2025-10-06","2025-10-06","2025-10-06","2023-06-06","2025-09-03","2023-08-29","2025-06-03","2024-09-04","2024-09-04","2025-09-24","2024-08-01","2023-03-07","2023-03-07","2023-03-07"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","VENLAFAXINE HCL","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","MODAFINIL","","","Select","Select",""],["","","DOXAZOSIN MESYLATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CALCIPOTRIENE","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","FLUOROURACIL","","","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":""}]}]}