{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lee N Smith","gend":0,"currentgend":"","add":"125 MORNING GLORY LN","city":"Sidney","state":"ME","zip":"04330","dob":"1957-12-09","age":"","mstatus":"","insh":"10000104768","cliId":"","pno":2076493650,"cno":"","email":"lnsmith@roadrunner.com","ename":"","eno":"","pphy":"PRESTON, DAVID G","ppno":2078731098,"pcpadd":"Mid Maine Medicine,325B Kennedy Memorial Dr","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"THAYER INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"125 MORNING GLORY LN","madd2":"","madd3":"","mcity":"Sidney","mstate":"ME","mzip":"04330","pcpfaxno":2078735461,"pcpnpi":1871559203,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5M16FP3CK78","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Q2112","S61210A","W231XXA","S0502XA","H18232","R29810","H6121","S0500XD","X58XXXD","G510","M25511","K4091","Z8673","Z7982","Z23","C44529","S0501XD","M542","R55","R197","N529","I6523","Z0001","R4182","M19011","G8929","D6851","R6889","D485","B078","R208","M7711","H18212","Z0000","I639","I499","G5611","G5621","M7581","D3611","M75101","Z0100","Z8679","Z832","Z0101","M47812","I4710","I4720","I493","R202","R29818","R200","I4891","I10","H9201","E7800","N401","L80","R3912","Z125","R5381","Z1331"],"date":["2024-04-12","2025-10-22","2025-10-22","2023-06-28","2023-06-28","2024-03-01","2023-10-30","2023-10-30","2023-10-30","2024-01-22","2024-07-03","2024-03-28","2024-03-28","2024-03-28","2025-10-22","2024-06-18","2023-10-30","2023-06-13","2023-07-14","2023-06-13","2023-06-13","2023-10-18","2023-01-23","2023-10-18","2024-07-11","2024-04-11","2024-03-27","2023-11-20","2025-06-10","2025-06-10","2025-06-10","2024-11-26","2023-06-26","2025-08-12","2024-03-01","2023-10-21","2024-04-25","2024-04-25","2024-07-03","2025-06-10","2024-07-11","2025-08-04","2024-03-27","2024-03-27","2023-03-14","2023-06-13","2023-11-21","2023-11-21","2023-11-21","2024-03-06","2023-10-18","2023-10-18","2023-10-19","2023-10-19","2023-10-19","2025-08-12","2023-01-23","2023-01-23","2023-01-23","2023-01-23","2023-10-18","2025-07-09"],"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":[["","","CEPHALEXIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","TERBINAFINE HCL","","","Select","Select",""],["","","OPZELURA","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","PIMECROLIMUS","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","EPITOL","","","Select","Select",""],["","","MOXIFLOXACIN","","","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":""}]}]}