{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"James M Krupa","gend":0,"currentgend":"","add":"39 JOSIAS LN","city":"OGUNQUIT","state":"ME","zip":"03907","dob":"1956-09-03","age":"","mstatus":"","insh":"10000109103","cliId":"","pno":6177801402,"cno":"","email":"","ename":"","eno":"","pphy":"COTE, JEFFREY T","ppno":2076460676,"pcpadd":"Wells Family Practice,59 Mile Rd","pcpcity":"Wells","pcpstate":"ME","pcpzip":"04090","pcpcounty":"","pcpid":"","pcpname":"WELLS FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 1313","madd2":"","madd3":"","mcity":"OGUNQUIT","mstate":"ME","mzip":"03907","pcpfaxno":2076466513,"pcpnpi":1467544668,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8JN7VW0QW46","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E7800","L820","E785","M25552","Z0000","Z1331","Z7189","J320","J323","L570","D485","D2261","D2272","L814","L821","Z0101","Z1211","Z800","D123","K635","J322","R040"],"date":["2025-08-21","2024-05-06","2024-08-13","2024-08-13","2025-02-21","2025-02-21","2025-02-21","2024-12-17","2024-12-17","2024-05-06","2024-05-06","2024-05-06","2024-05-06","2024-05-06","2024-05-06","2024-07-30","2025-05-28","2025-05-28","2025-05-28","2025-05-28","2023-12-12","2023-12-12"],"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":[["","","ACETAZOLAMIDE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","CLENPIQ","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","ATOVAQUONE-PROGUANIL HCL","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}