{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Daniel S Gilley","gend":0,"currentgend":"","add":"5 LEONARD PL","city":"WEST ENFIELD","state":"ME","zip":"04493","dob":"1953-01-21","age":"","mstatus":"","insh":"10000115207","cliId":"","pno":2077323752,"cno":"","email":"gilleydaniel@yahoo.com","ename":"","eno":"","pphy":"AQUILINA, JOSEPH","ppno":2072230965,"pcpadd":"PO BOX 99,","pcpcity":"LINCOLN","pcpstate":"ME","pcpzip":"44570099","pcpcounty":"","pcpid":"","pcpname":"HEALTH ACCESS NETWORK","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 67","madd2":"","madd3":"","mcity":"WEST ENFIELD","mstate":"ME","mzip":"04493","pcpfaxno":2077946777,"pcpnpi":1104835669,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2M94MC2KJ65","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","K861","Z1329","K311","R935","Z0000","R1031","Z0189","R7401","R109","K8050","K831","F419","K449","R059","K769","Z09","K8309","Z743","K860","K6389","K838","K3189","R140","K7030","K828","Z4682","R110","R531","K2090","K31819"],"date":["2025-10-29","2025-06-04","2025-06-04","2024-05-09","2024-05-09","2024-09-03","2024-05-28","2025-10-24","2025-10-24","2025-10-24","2025-10-29","2025-10-29","2025-10-29","2024-05-20","2025-10-23","2025-10-23","2024-05-31","2025-10-30","2024-05-08","2025-11-10","2024-05-08","2025-10-24","2024-05-10","2024-05-07","2024-05-08","2024-05-28","2025-10-24","2025-10-23","2025-10-23","2024-05-09","2024-05-09"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","FLUVOXAMINE MALEATE","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","URSODIOL","","","Select","Select",""],["","","OMEPRAZOLE","","","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":""}]}]}