{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donald E Brown","gend":0,"currentgend":"","add":"12 DROWNE RD APT 120","city":"CUMBERLAND CENTER","state":"ME","zip":"04021","dob":"1933-07-31","age":"","mstatus":"","insh":"00007665600","cliId":"","pno":"2073830226","cno":"","email":"dbrown7016@gmail.com","ename":"","eno":"","pphy":"ZAGER, SAMUEL","ppno":"2078282402","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 - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"12 DROWNE RD APT 120","madd2":"","madd3":"","mcity":"CUMBERLAND CENTER","mstate":"ME","mzip":"04021","pcpfaxno":"2078287850","pcpnpi":"1821383860","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6CR1JV9JV90","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":["N200","L84","E1142","E1159","E1149","E1140","E1129","E1136","E1151","B351","M79674","Z23","N401","C61","R0609","I10","R0602","R0600","R0789","R000","I499","R002","I4710","I440","I351","N390","D649","M1711","M25561","L819","H53131","H40023","E119","K625","I2510","E039","N3090","G459","D539","K921","Z87891","Z7982","R5383","N179","N189","Z8673","I6523","S61412A","W010XXA","Z87440","N138","H5461","H31011","H43812","K922","R519","L03114","L814","G319","R9089","R296","R531","D123","K635","K449","K5730","K5751","D122","R55","R4701","R4182","D62","K319","K2950","K5140","Z4802","I110","M549"],"date":["2024-05-13","2023-06-21","2024-01-10","2024-01-10","2024-01-10","2026-02-19","2026-02-19","2026-02-19","2026-02-19","2024-01-10","2024-01-10","2025-11-03","2025-12-12","2025-12-12","2026-02-11","2026-02-13","2023-11-27","2023-11-27","2023-12-06","2023-12-20","2023-12-07","2024-06-11","2023-12-20","2023-12-20","2024-01-12","2025-07-07","2026-02-21","2026-01-05","2026-01-05","2025-11-11","2025-09-15","2025-09-15","2026-02-13","2025-12-02","2026-02-06","2025-10-27","2025-08-04","2025-06-15","2025-07-28","2026-01-21","2026-01-02","2025-11-12","2025-07-07","2025-07-07","2025-07-07","2026-02-02","2025-05-14","2024-10-11","2024-10-11","2025-09-17","2025-12-12","2024-08-27","2024-08-27","2024-08-27","2026-02-13","2026-02-02","2024-10-16","2025-11-10","2025-05-14","2025-05-14","2026-02-11","2025-06-27","2026-02-13","2026-01-02","2026-01-02","2026-01-02","2026-02-11","2026-01-02","2026-02-11","2025-05-14","2025-05-14","2026-02-19","2026-01-02","2026-01-02","2026-01-02","2024-10-21","2025-09-03","2023-02-22"],"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":[["","","HYDROCHLOROTHIAZIDE","12.5 MG","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","LEVOTHYROXINE","50 MCG","","Select","Select",""],["","","ENALAPRIL MALEATE","","","Select","Select",""],["","","SERTRALINE","50 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","TAMSULOSIN","0.4 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE","","","Select","Select",""],["","","Mupirocin 2 % Ointment Glenmark","","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","ALLOPURINOL","300 MG","","Select","Select",""],["","","BUMETANIDE","1 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","Peg 3350\/Electrolytes","236 GM","","Select","Select",""],["","","ENALAPRIL","20 MG","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","Triamcinolone Acet 0.025 % Cream Padagis","","","Select","Select",""],["","","RELION PRIME TEST STRIPS","","","Select","Select",""],["","","RELION PRIME","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","ATORVASTATIN","10 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","ATENOLOL","25 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.00025","","Select","Select",""],["","","PEG","3350\/ELECTROLYTES 236","","Select","Select",""],["","","MUPIROCIN","0.02","","Select","Select",""],["","","SPIKEVAX","","","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":""}]}]}