{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michael T Healy","gend":0,"currentgend":"","add":"48 UNION ST 301","city":"BRUNSWICK","state":"ME","zip":"04011","dob":"1943-01-25","age":"","mstatus":"","insh":"10000106491","cliId":"","pno":2076509514,"cno":"","email":"mthealy52@gmail.com","ename":"","eno":"","pphy":"DAVIS, SARAH M","ppno":2077984400,"pcpadd":"MaineHealth Primary Care Family Medicine,329 Maine St Ste A200","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"48 UNION ST 301","madd2":"","madd3":"","mcity":"BRUNSWICK","mstate":"ME","mzip":"04011","pcpfaxno":2076185688,"pcpnpi":1003891177,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3EK5P60UC60","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":["G4733","Z95810","I480","R942","J849","J984","G2581","I4720","S50869A","N1832","E278","I5043","D0361","I4819","I5042","I421","I5032","C44219","D0422","D0439","S0990XA","R930","R9089","N401","G4731","I5022","C44629","D0461","J8410","R918","I110","I442","K219","J439","R0602","Z9989","J328","Z950","R0989","I50812","J449","G4730","Z7689","I4891","Z7901","G4719","H2512","J189","G4739","Z0101","H5212","H52222","H524","R059","R911","I2510","I5033","R932","I5023","Z09","I083","I77810","I499","I422","Z5189","Z0000","I340","I7121","J441","L570","G629","R008","I493","I130","Z23","D492","R590","J929","N281","N289","K7689","K429","K449","J40","D225","L814","L821","L578","N182","I200","R9439","D6869","E1122","E1142","I700","L858","G603","M79671","M79672","B351","C44311","I080","C44612","D044","I10","L0390","J90","I5020","Z515","I1310","H938X9","Z8673","H109","S00412A","N138","E876","I088","R931","Z959","J181","J811","I509","J159","I517","M109","N189","J9601","E782","I2720","N178","J939","I3139","R0600","Z789","J918","R5383","C44622","Q828","I429","C4442","Z85828","I77819","R55","R6889","N2889","R935","M25521","D0430","M19021","B079","W57XXXA","H903"],"date":["2025-11-10","2025-09-29","2025-02-14","2025-05-14","2025-06-23","2025-06-23","2025-09-08","2025-02-18","2023-10-12","2025-05-21","2024-07-06","2025-08-11","2025-05-19","2025-02-18","2025-07-07","2025-11-04","2023-05-19","2024-12-31","2024-10-02","2024-10-02","2025-08-11","2025-08-11","2025-08-11","2024-02-05","2023-12-19","2025-11-10","2024-04-08","2024-12-31","2023-10-31","2025-10-09","2025-02-19","2025-02-19","2025-02-19","2025-01-14","2025-07-07","2024-12-06","2023-09-19","2025-02-19","2025-02-19","2024-02-01","2025-11-10","2023-06-12","2025-09-17","2023-06-12","2023-06-12","2023-11-20","2025-11-05","2024-02-01","2025-02-12","2025-09-11","2025-09-11","2025-09-11","2025-09-11","2023-07-25","2025-11-10","2025-10-09","2025-02-20","2023-05-24","2025-02-24","2025-08-19","2025-08-22","2025-08-22","2023-05-19","2023-05-29","2025-01-03","2025-06-11","2023-08-09","2023-09-15","2024-07-26","2025-03-26","2025-09-17","2025-09-04","2025-09-04","2025-07-07","2024-03-06","2025-03-26","2025-10-09","2025-10-09","2024-06-17","2024-06-17","2024-07-06","2024-07-06","2024-07-06","2024-07-23","2025-03-26","2025-03-26","2025-03-26","2024-03-13","2023-04-05","2025-02-17","2025-02-17","2023-12-11","2023-12-11","2023-12-11","2024-12-06","2025-04-17","2025-07-31","2025-07-31","2025-07-31","2025-07-31","2023-04-03","2025-02-24","2025-05-20","2025-05-20","2025-05-21","2024-02-10","2025-02-13","2025-09-29","2025-09-29","2025-08-11","2024-08-24","2024-01-24","2024-07-23","2024-07-23","2023-05-25","2025-07-14","2025-08-12","2025-08-22","2025-02-14","2024-01-02","2025-02-13","2025-02-18","2023-12-22","2024-12-06","2024-01-08","2023-12-22","2023-12-24","2023-09-15","2025-08-22","2023-12-30","2025-06-23","2025-06-23","2023-05-29","2025-09-17","2024-01-09","2023-05-29","2024-04-15","2024-12-03","2025-02-14","2025-05-05","2025-03-26","2025-08-12","2025-08-12","2023-10-11","2024-11-15","2023-04-06","2024-02-01","2024-12-03","2024-02-01","2024-05-17","2023-10-12","2025-02-10"],"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":[["","","TAMSULOSIN HCL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","NEUPRO","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","MODAFINIL","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","RISPERIDONE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","SCOPOLAMINE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","LAGEVRIO (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":""}]}]}