{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dennis G Dickinson","gend":0,"currentgend":"","add":"22 OLD COUNTY RD","city":"LEBANON","state":"ME","zip":"04027","dob":"1958-02-13","age":"","mstatus":"","insh":"10000103794","cliId":"","pno":2074594203,"cno":"","email":"dennyod@hotmail.com","ename":"","eno":"","pphy":"STEPHENS, CHRISTINA M","ppno":6038718227,"pcpadd":"Wakefield Family Medicine,131 Meadow St","pcpcity":"Sanbornville","pcpstate":"NH","pcpzip":"03872","pcpcounty":"","pcpid":"","pcpname":"WAKEFIELD FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"22 OLD COUNTY RD","madd2":"","madd3":"","mcity":"LEBANON","mstate":"ME","mzip":"04027","pcpfaxno":6038718285,"pcpnpi":1720610611,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8U73XK5DP17","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D122","S61012A","E785","N401","R351","R7309","R9431","Z1211","Z83719","K635","K5730","R0602","Z87891","E669","R0600","Z23","Z0001","W269XXA","J209","R0789","R079","J811","J302","Z125","R7303","Z136","I77811","G64","I350","I7121","D225","L814","L821","B360","L570","L820","L298","L538","J40","J329","Z0101","G4733","R001","R002","I10","M25511","I38","I719","G629","R0902","R5383","R519","I517","I351","L300","L851","R918"],"date":["2024-05-22","2024-11-13","2024-06-25","2023-12-22","2024-02-26","2024-06-25","2025-08-25","2024-05-22","2024-05-22","2024-05-22","2024-05-22","2024-08-27","2025-02-18","2024-06-25","2024-06-25","2023-12-22","2025-01-27","2024-11-13","2023-10-31","2025-08-22","2025-08-26","2024-04-30","2024-04-30","2025-01-27","2025-01-27","2025-02-18","2025-02-18","2024-02-26","2025-10-29","2024-02-27","2024-02-21","2024-02-21","2024-02-21","2024-02-21","2024-02-21","2024-02-21","2024-02-21","2024-02-21","2023-12-11","2023-12-11","2024-11-27","2025-09-24","2025-10-29","2025-09-24","2022-12-21","2022-12-21","2025-10-29","2025-10-29","2023-08-01","2025-08-23","2025-08-22","2025-08-22","2025-08-23","2025-08-23","2023-02-08","2023-02-08","2025-08-22"],"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":[["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","PREVNAR 20","","","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":""}]}]}