{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"George P Canales","gend":0,"currentgend":"","add":"244 PLEASANT HILL RD","city":"HOLLIS CENTER","state":"ME","zip":"04042","dob":"1942-08-26","age":"","mstatus":"","insh":"10000109031","cliId":"","pno":2072989559,"cno":"","email":"declined@082223.com","ename":"","eno":"","pphy":"POULIN, SAMUEL J","ppno":2078282402,"pcpadd":"Martins Point Health Care,331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"244 PLEASANT HILL RD","madd2":"","madd3":"","mcity":"HOLLIS CENTER","mstate":"ME","mzip":"04042","pcpfaxno":2078282433,"pcpnpi":1841827003,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6C26T00DV86","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":["L570","M1711","T8484XA","M47816","M419","M5450","I350","I358","I351","I4891","S0502XA","N281","N200","N403","R188","Z7901","N170","R079","S5012XA","Y93H9","R9431","Z23","U071","K828","N400","N184","R609","E559","R918","R791","Z87891","Z0101","S8261XA","M25571","M19071","I82611","R601","R7301","E039","D531","E785","I3481","I498","R9389","J9811","I10","R801","N2581","J9601","J189","N178","K219","N185","J984","I25110","I5189","I493","I499","R531","I4892","I491","R109","J90","Z79899","Z0189","R7989","R1013","N401","R3121","R059","M19011","H401132","N179","Z7682","H43813","H5713","M4156","M160","D492","I70219","I080","I77810","M5459","I130","I5032","R600","D631","I2510","R0602","I739","I4819","T8484XD","Z96652","M19012","R634","J449"],"date":["2025-07-14","2025-04-17","2025-04-17","2025-07-29","2025-07-29","2025-07-29","2025-06-05","2025-09-11","2024-11-22","2025-06-03","2025-02-14","2025-08-28","2025-08-28","2025-08-28","2025-08-28","2025-07-08","2025-09-15","2025-07-16","2025-02-14","2025-02-14","2025-09-17","2025-02-12","2025-08-28","2025-07-17","2025-07-17","2025-09-15","2025-08-08","2024-03-11","2025-09-09","2025-05-21","2025-07-29","2023-10-31","2025-08-05","2025-08-05","2025-08-05","2025-09-17","2025-05-13","2024-08-16","2024-08-16","2024-08-16","2024-08-16","2025-06-05","2025-05-08","2025-07-16","2025-09-17","2024-03-11","2023-09-11","2024-05-09","2025-09-07","2025-09-17","2025-09-07","2025-07-07","2025-08-29","2025-09-17","2025-07-07","2025-09-11","2025-09-11","2025-09-11","2025-09-11","2025-07-08","2025-07-08","2025-06-10","2025-09-07","2025-07-29","2025-09-12","2025-05-15","2025-07-17","2023-07-24","2023-07-24","2025-08-28","2025-04-30","2024-07-17","2024-04-19","2024-09-18","2024-07-17","2024-07-17","2025-07-29","2025-02-19","2024-04-16","2025-06-26","2025-09-15","2024-08-15","2025-07-29","2025-05-15","2025-05-15","2025-08-31","2024-01-11","2025-08-26","2025-08-26","2025-06-26","2025-06-04","2023-12-01","2023-12-01","2023-12-01","2024-06-25","2024-02-24"],"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",""],["","","FUROSEMIDE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","SYNTHROID","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","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":""}]}]}