{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carl F Gosselin","gend":0,"currentgend":"","add":"34 MARLBORO AVE","city":"Augusta","state":"ME","zip":"04330","dob":"1945-09-03","age":"","mstatus":"","insh":"00008646600","cliId":"","pno":"2076239204","cno":"","email":"declined@022624.com","ename":"","eno":"","pphy":"ANDERSON, KATHARINE M","ppno":"2076261561","pcpadd":"Family Medicine Institute,15 E Chestnut St","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"FAMILY MEDICINE INSTITUTE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"2076239204","add2":"","add3":"","madd1":"34 MARLBORO AVE","madd2":"","madd3":"","mcity":"Augusta","mstate":"ME","mzip":"04330","pcpfaxno":"2076261849","pcpnpi":"1003254178","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3XW6AF9QD60","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","Z87891","Z122","M1711","M25461","M25561","Z0000","I4811","M5431","I10","M5416","N401","R319","Z7901","I509","I4891","J449","F32A","Z23","R0602","I517","I4510","R059","R000","R509","I110","I5033","A419","B999","J9601","Z1152","J189","Z0100","H35373","H04123","R69","H524","R0902","N281","I7143","I2510","K5730","H52222","Z961","H26492","R609","G4730","N320","Z0101","R3129","I4821","R42","M25511","M25512","R8289","R600","D6869","E785","M47816","M5450","R0603","M5459","W000XXA","M549","R069","R0689","Z20822","I080","I77810","M5126","R102","M47817","M9909","M9903","M9905","M9904"],"date":["2025-10-20","2023-07-18","2023-05-03","2023-06-09","2023-06-05","2023-06-05","2025-11-19","2023-06-09","2023-06-02","2024-09-10","2023-06-09","2024-11-07","2024-10-17","2023-07-18","2025-05-28","2025-02-26","2025-02-26","2023-10-16","2023-10-19","2024-03-22","2023-11-27","2023-11-27","2023-11-27","2023-11-27","2023-11-27","2026-03-02","2024-03-23","2024-03-22","2024-03-22","2024-03-23","2024-03-22","2024-03-23","2024-04-24","2025-05-22","2025-05-22","2024-04-03","2024-07-10","2024-03-22","2024-10-17","2024-10-17","2024-10-17","2024-10-17","2024-06-25","2024-06-25","2024-06-25","2025-10-20","2025-10-20","2025-08-29","2025-05-22","2024-10-03","2025-11-14","2025-07-10","2023-03-29","2023-03-29","2024-10-03","2025-07-10","2024-09-10","2023-02-20","2023-02-10","2023-02-20","2023-01-27","2023-01-27","2023-01-27","2023-01-26","2023-01-26","2023-01-26","2023-01-26","2023-01-26","2023-01-26","2023-01-27","2023-01-26","2023-01-26","2023-01-27","2023-01-27","2023-01-27","2023-01-27"],"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":[["","","JARDIANCE","","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","LISINOPRIL","10 MG","","Select","Select",""],["","","SERTRALINE","50 MG","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","METOPROLOL TART","100 MG","","Select","Select",""],["","","TAMSULOSIN","0.4 MG","","Select","Select",""],["","","SIMVASTATIN","40 MG","","Select","Select",""],["","","METOPROLOL SUCC","100 MG","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","CEFPODOXIME","200 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","AMLODIPINE","5 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","SPIRIVA RESPIMAT","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","MONTELUKAST","10 MG","","Select","Select",""],["","","CYCLOBENZAPRINE","10 MG","","Select","Select",""],["","","INCRUSE ELLIPTA","","","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":""}]}]}