{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"James R Erwin","gend":0,"currentgend":"","add":"111 ROYAL POINT RD","city":"YARMOUTH","state":"ME","zip":"04096","dob":"1953-06-20","age":"","mstatus":"","insh":"10000104916","cliId":"","pno":2078466665,"cno":2072329025,"email":"jerwin111@icloud.com","ename":"","eno":"","pphy":"AIKEN, DOUGLAS","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":"111 ROYAL POINT RD","madd2":"","madd3":"","mcity":"YARMOUTH","mstate":"ME","mzip":"04096","pcpfaxno":2078741483,"pcpnpi":1093774119,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7GD7C51EE44","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J029","N401","R351","F5221","Z0000","K4020","Z1211","D120","K5730","E7800","R7303","M79604","M25651","S76311A","Z01818","R002","Z0100","N400","K219","E039","E785","H903","R0789","Z09","Z125","J069","Z23","I4710","I5030","M1990","R519","R079"],"date":["2025-03-28","2025-07-08","2025-01-13","2025-07-08","2025-01-20","2025-04-21","2025-08-13","2025-08-13","2025-08-13","2025-01-13","2025-01-13","2025-03-19","2025-03-19","2025-02-17","2025-02-27","2024-02-08","2024-07-01","2025-02-27","2025-04-21","2025-03-05","2025-03-05","2025-08-01","2024-02-08","2025-05-06","2024-01-11","2023-12-21","2024-01-17","2024-02-08","2024-02-08","2025-04-21","2025-04-21","2023-09-25"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","PAXLOVID (EUA)","","","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":""}]}]}