{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Guy E Phillips","gend":0,"currentgend":"","add":"27 MAPLE ST","city":"WILTON","state":"ME","zip":"04294","dob":"1947-08-09","age":"","mstatus":"","insh":"10000112874","cliId":"","pno":2076455224,"cno":"","email":"gphillips@myfairpoint.net","ename":"","eno":"","pphy":"SWEETSER, MICHELLE","ppno":"","pcpadd":"4 CLEMENT WAY,","pcpcity":"BELGRADE","pcpstate":"ME","pcpzip":"49174370","pcpcounty":"","pcpid":"","pcpname":"WESTERN MAINE FAMILY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"27 MAPLE ST","madd2":"","madd3":"","mcity":"WILTON","mstate":"ME","mzip":"04294","pcpfaxno":2074953353,"pcpnpi":1568820264,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7NV0NM5WN25","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":["R0789","J189","Z0100","R55","N401","E11620","E871","I214","I2510","R931","E11628","L0889","M1611","M25551","G8929","M47816","R079","E1159","R9439","I10","I4510","R9431","I959","E1169","Z23","M19012","M25512","Z981","I2119","J13","E119","R000","I444","Z136","I340","B953","R7881","R918","R059","R509","M19072","R112","I5189","R7989","D696","I314"],"date":["2025-06-03","2024-08-07","2025-10-08","2025-06-06","2025-05-28","2025-05-28","2025-05-28","2025-06-20","2025-06-09","2025-06-09","2025-05-28","2024-08-03","2024-10-01","2024-10-01","2024-02-15","2024-02-15","2025-06-09","2025-06-10","2025-06-10","2025-06-10","2025-06-20","2025-06-20","2025-07-16","2025-09-03","2024-02-08","2025-05-30","2025-05-30","2025-05-30","2025-06-05","2024-08-26","2025-06-05","2024-08-03","2024-08-03","2025-07-01","2025-06-10","2024-08-26","2024-08-07","2025-06-03","2024-08-05","2024-08-05","2024-08-03","2024-08-05","2025-06-04","2025-06-07","2024-08-20","2025-06-07"],"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",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 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":{"indx":[],"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":""}]}]}