{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ralph P Norris","gend":0,"currentgend":"","add":"18 NORTON FARM RD","city":"FREEPORT","state":"ME","zip":"04032","dob":"1936-01-02","age":"","mstatus":"","insh":"10000010982","cliId":"","pno":"2078656596","cno":"","email":"r-anorris57@comcast.net","ename":"","eno":"","pphy":"DOBIESKI, STEVEN T","ppno":"2077745816","pcpadd":"InterMed,84 Marginal Way Ste 800","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"18 NORTON FARM RD","madd2":"","madd3":"","mcity":"FREEPORT","mstate":"ME","mzip":"04032","pcpfaxno":"2078741483","pcpnpi":"1942279617","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3ER7P44CW79","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I480","R21","E871","I10","Z23","H26493","H353112","H3412","Z0000","Z7901","R350","H26491","R600","R011","I350","H35371","H26492","Z953","I442","I2510","R931","I2720","I2089","I71011","K5909","I083","R001","Z950","Z09","Z006","R079","J90","K219","I4811","I708","I70202","H52201","R1909","I081","Z952","I5032","D696","D649","Z954","E785","R4182","I080","R5383","M542","R0609","K4090","Z01810","I700","I6523","Z452","I4891","I724","R1030","R1904","L97811","I83018","R52","I499","R1032","R0989","M50322","I459","E7800","A64","R300","M109"],"date":["2025-05-09","2023-05-26","2023-06-16","2025-08-26","2024-10-08","2023-12-13","2026-01-16","2026-01-16","2025-02-10","2024-05-30","2024-03-07","2024-02-05","2024-11-18","2025-01-07","2025-08-01","2026-01-16","2026-01-16","2026-01-13","2025-12-08","2025-09-03","2025-08-05","2025-08-05","2025-05-22","2025-06-25","2026-02-05","2025-06-25","2025-08-01","2025-12-08","2025-06-27","2025-06-27","2025-06-19","2025-08-07","2025-08-07","2025-12-08","2025-07-02","2025-07-02","2024-11-08","2026-01-23","2025-08-01","2025-07-02","2025-09-15","2024-10-28","2025-09-23","2025-06-26","2025-08-07","2025-08-07","2025-06-26","2024-10-28","2024-10-28","2024-10-28","2026-01-05","2025-06-18","2025-06-18","2025-06-20","2025-06-25","2025-08-04","2026-02-09","2025-11-06","2025-11-06","2024-11-18","2024-11-18","2025-07-02","2025-06-03","2025-11-22","2026-02-09","2024-10-28","2025-08-08","2025-07-29","2023-03-08","2023-02-21","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":[["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","NITROGLYCERIN","0.4 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","Mupirocin 2 % Ointment Padagis","","","Select","Select",""],["","","ATORVASTATIN","80 MG","","Select","Select",""],["","","ACETAZOLAMIDE","250 MG","","Select","Select",""],["","","LOSARTAN","100 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","PANTOPRAZOLE","20 MG","","Select","Select",""],["","","ISOSORBIDE MONONITRATE","30 MG","","Select","Select",""],["","","DOXAZOSIN","4 MG","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","SIMVASTATIN","20 MG","","Select","Select",""],["","","AMLODIPINE","5 MG","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","WARFARIN","2.5 MG","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","MUPIROCIN","0.02","","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":""}]}]}