{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ralph C Lane","gend":0,"currentgend":"","add":"18 KARLAS WAY","city":"SIDNEY","state":"ME","zip":"04330","dob":"1942-11-16","age":"","mstatus":"","insh":"10000010745","cliId":"","pno":"2077161379","cno":"2073145417","email":"rlanesr1@roadrunner.com","ename":"","eno":"","pphy":"CIANFARANO, ROBERT P","ppno":"2074652181","pcpadd":"4 CLEMENT WAY,","pcpcity":"BELGRADE","pcpstate":"ME","pcpzip":"04917","pcpcounty":"","pcpid":"","pcpname":"OAKLAND FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"18 KARLAS WAY","madd2":"","madd3":"","mcity":"SIDNEY","mstate":"ME","mzip":"04330","pcpfaxno":"2074654629","pcpnpi":"1962591271","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1HY7D46TK46","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I214","I350","I200","I10","E785","I080","I219","I2510","D509","F17210","G4700","R419","R079","I6381","D649","Z87891","I252","R42","Z743","I6523","Z0101","M25562","R6889","I25111","M1712","Z96642","Z98890","R4189","R413","R011","R9082","G319","G459","K121","J029","G3184","Z0000","Z23","R410","R0600","J439","R778","K3182","K219","K922","D472","E854","D500","F419","J208","B9689","R0609","J9811","I25110","I110","R2231","Z955","K250","D62","I209","M170","R21","K264","R41841","M7021","K5732","N200","R109","B351","K31819","C4441","I352","L989","M7989","Z862","Z8719","S83242A","S83282A","L821","Z85828","L570","M1990","Z0001","Z1283","X58XXXA","Z4802","D485","J449","R059","Z01810","R001","M1711","M23222","D508","Z96652","Z09"],"date":["2023-04-11","2026-02-09","2023-04-07","2026-02-09","2025-02-04","2025-01-07","2023-04-10","2025-08-12","2025-11-11","2023-04-08","2024-02-23","2023-04-08","2024-05-10","2023-04-21","2025-04-24","2025-11-12","2023-07-03","2023-08-02","2023-04-08","2023-05-16","2023-05-24","2025-02-11","2023-05-24","2026-02-13","2023-06-06","2023-06-06","2023-06-06","2023-08-02","2023-11-30","2024-02-08","2023-09-24","2023-09-24","2023-09-24","2023-10-12","2023-10-12","2023-10-12","2023-11-30","2023-11-30","2024-01-10","2024-01-10","2024-01-10","2024-01-11","2024-11-06","2024-11-06","2024-04-15","2025-11-11","2024-02-06","2024-09-09","2024-02-23","2024-04-15","2024-04-15","2024-05-10","2024-05-10","2024-05-10","2024-05-10","2024-05-20","2024-05-10","2024-05-13","2024-05-13","2024-05-11","2026-02-27","2024-06-21","2024-07-02","2024-08-29","2025-11-12","2024-09-16","2024-09-16","2024-09-16","2025-04-01","2024-11-06","2025-05-22","2025-05-07","2025-10-15","2025-10-23","2025-08-12","2025-05-05","2025-07-23","2025-07-23","2025-08-14","2025-08-14","2025-08-14","2026-02-27","2025-01-03","2025-02-12","2025-07-23","2025-03-20","2025-03-06","2024-12-09","2024-12-09","2026-03-05","2026-03-05","2025-07-15","2025-07-15","2023-03-30","2023-03-24","2025-02-10"],"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":[["","","TEMAZEPAM","30 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Perrigo","","","Select","Select",""],["","","FLUTICASONE PROP","50 MCG","","Select","Select",""],["","","CYCLOBENZAPRINE","5 MG","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","DONEPEZIL","5 MG","","Select","Select",""],["","","AMLODIPINE","10 MG","","Select","Select",""],["","","CARVEDILOL","12.5 MG","","Select","Select",""],["","","ATORVASTATIN","40 MG","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","TERBINAFINE","250 MG","","Select","Select",""],["","","MECLIZINE","25 MG","","Select","Select",""],["","","SPIKEVAX","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE","30 MG","","Select","Select",""],["","","TRAZODONE","50 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","NITROGLYCERIN","0.4 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","BACLOFEN","10 MG","","Select","Select",""],["","","METOPROLOL SUCC","25 MG","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.001","","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":""}]}]}