{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jason T Esler","gend":0,"currentgend":"","add":"22 UNITY RD","city":"ALBION","state":"ME","zip":"04910","dob":"1960-02-12","age":"","mstatus":"","insh":"10000127503","cliId":"","pno":2073144729,"cno":"","email":"","ename":"","eno":"","pphy":"CHAMBERLAIN, DEAN E","ppno":2074379388,"pcpadd":"Lovejoy Health Center,7 School St Ste 1","pcpcity":"Albion","pcpstate":"ME","pcpzip":"04910","pcpcounty":"","pcpid":"","pcpname":"LOVEJOY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 167","madd2":"","madd3":"","mcity":"ALBION","mstate":"ME","mzip":"04910","pcpfaxno":2076261849,"pcpnpi":1922360411,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8V33FP2TV60","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","E782","S61212D","X58XXXD","M19041","M20011","L0889","S61312D","M25531","M1811","D2361","S61219A","S61210D","W260XXD","S61212A","W260XXA","X58XXXA","Z0000","M67431","R2231","D72820","M25841","M7989","M19011","M25511","M79671","S61219D","D485","D225","L814","L821","L218"],"date":["2025-05-09","2025-05-09","2025-08-14","2025-08-14","2025-10-30","2025-09-11","2025-11-07","2025-08-07","2025-03-24","2025-10-30","2025-02-25","2025-11-03","2025-10-30","2025-10-30","2025-07-31","2025-07-31","2025-07-31","2025-05-14","2025-04-28","2025-03-20","2025-08-06","2025-10-30","2025-11-07","2025-04-22","2025-04-22","2025-03-14","2025-06-20","2025-02-25","2025-02-25","2025-02-25","2025-02-25","2025-02-25"],"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":[["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","KETOCONAZOLE","","","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":""}]}]}