{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jeffrey A Deletetsky","gend":0,"currentgend":"","add":"43 WOODSIDE DR","city":"LISBON","state":"ME","zip":"04250","dob":"1958-10-05","age":"","mstatus":"","insh":"10000109875","cliId":"","pno":2074811006,"cno":"","email":"jdeletetsky48@gmail.com","ename":"","eno":"","pphy":"DECK, MARCUS M","ppno":2077984400,"pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"43 WOODSIDE DR","madd2":"","madd3":"","mcity":"LISBON","mstate":"ME","mzip":"04250","pcpfaxno":2077984018,"pcpnpi":1891717872,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6JF4T82YG50","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":["M7552","K5521","K921","K2950","M4726","F411","C61","N401","M51370","M47816","R850","Z08","Z8546","Z923","K2100","Z1211","Z86010","Z800","K635","Z136","R7309","M160","M25559","M5450","D122","Z23","K627","R21","M549","K8590","R1013","Z0101","M25512","K429","N281","K5790","K7689","T50901A","I493","R1310","K219","M25552","Z0189","Z09","Z13220"],"date":["2025-03-26","2025-08-15","2025-08-15","2025-01-22","2025-02-25","2024-02-26","2025-05-05","2024-02-01","2024-10-30","2025-11-06","2025-02-11","2024-07-11","2024-07-11","2024-07-11","2025-04-16","2023-12-13","2023-12-13","2023-12-13","2023-12-13","2024-09-18","2025-09-26","2025-11-06","2025-11-06","2025-11-06","2023-12-13","2024-09-25","2025-05-29","2025-11-05","2024-10-30","2025-01-08","2024-12-11","2024-12-04","2025-04-02","2025-01-08","2025-01-08","2025-01-08","2025-01-08","2025-02-15","2025-02-15","2025-01-22","2025-09-26","2025-07-22","2024-12-12","2025-04-16","2025-09-26"],"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":[["","","LORAZEPAM","","","Select","Select",""],["","","VALSARTAN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","MESALAMINE","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","XIIDRA","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","IBU","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","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":""}]}]}