{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Edward B Simmons","gend":0,"currentgend":"","add":"252 SEA MEADOWS LN","city":"YARMOUTH","state":"ME","zip":"04096","dob":"1946-01-30","age":"","mstatus":"","insh":"10000104873","cliId":"","pno":2078466177,"cno":"","email":"Edwardsimmons1946@gmail.com","ename":"","eno":"","pphy":"PIERCE, DANIEL C","ppno":2078469013,"pcpadd":"InterMed,259 Main St","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"252 SEA MEADOWS LN","madd2":"","madd3":"","mcity":"YARMOUTH","mstate":"ME","mzip":"04096","pcpfaxno":2078741483,"pcpnpi":1861451080,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5RA9TX6NM00","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4891","I4892","M1612","M25539","I480","M25551","M25651","M25351","R2689","C44310","M0600","Z79899","M353","Z23","N390","R339","N401","L570","D485","L821","L578","M2170","Z96641","H6123","M2550","R000","Z471","Z96643","A000","E785","R4182","R7982","M1711","C44319","R6889","H6122","M25552","Z0001","B079","M25559","M7989","M180","G5602","D649","I484","Z7901","I081","I700","S82891A","M79605","M79671","M792","R200","M25641","M25642","I499","Z96642","Z136","M19071","M7731","M19032","M19031","M19041","M19042","H6692","Z6823"],"date":["2023-11-13","2023-11-13","2025-03-17","2023-08-10","2025-05-07","2025-06-19","2025-06-19","2025-06-19","2025-06-19","2025-10-07","2025-08-13","2025-05-09","2025-05-09","2025-11-06","2025-11-06","2025-11-06","2025-11-06","2025-06-11","2025-06-11","2025-06-11","2025-08-06","2025-03-17","2024-11-12","2023-07-10","2023-07-10","2023-11-01","2025-03-28","2025-03-17","2025-03-19","2025-03-17","2025-03-17","2023-05-23","2023-03-27","2025-08-06","2023-01-01","2025-03-07","2024-11-12","2024-12-12","2024-01-23","2023-06-06","2024-09-16","2023-05-15","2023-05-15","2025-01-09","2023-11-15","2023-11-15","2023-11-15","2023-11-15","2024-09-10","2025-04-29","2024-10-03","2024-09-09","2024-09-09","2023-05-15","2023-05-15","2023-11-15","2025-03-28","2023-07-17","2024-10-03","2024-09-09","2024-03-20","2024-03-20","2024-03-20","2024-03-20","2025-03-07","2025-03-07"],"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":[["","","TRANEXAMIC ACID","","","Select","Select",""],["","","TIADYLT ER","","","Select","Select",""],["","","DILTIAZEM 24HR ER","","","Select","Select",""],["","","FLECAINIDE ACETATE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","METHOTREXATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","KEVZARA","","","Select","Select",""],["","","LEFLUNOMIDE","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","XARELTO","","","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":""}]}]}