{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Leon G Benton","gend":0,"currentgend":"","add":"PO BOX 254","city":"Kittery","state":"ME","zip":"03904","dob":"1942-06-20","age":"","mstatus":"","insh":"10000011342","cliId":"","pno":"2074389699","cno":"","email":"ladman69@gmail.com","ename":"","eno":"","pphy":"COPPINS, NICHOLAS J","ppno":"2074394430","pcpadd":"Kittery Family Practice,35 Walker St Ste 100","pcpcity":"Kittery","pcpstate":"ME","pcpzip":"03904","pcpcounty":"","pcpid":"","pcpname":"KITTERY FAMILY PRACTICE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 254","madd2":"","madd3":"","mcity":"Kittery","mstate":"ME","mzip":"03904","pcpfaxno":"2074390968","pcpnpi":"1568937159","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5KR7R23YF65","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","L570","L578","L821","Z1283","Z08","J449","R059","T827XXD","H402223","H25811","H04123","E119","D2261","D2262","D225","R0609","G4709","M5450","R5383","L820","L538","L298","R200","D72819","G459","R001","E785","D509","R410","I6782","I6503","J8410","I700","I10","I2510","I2699","Z0101","I7143","G4700","R918","J9809","J984","K922","R590","Z86711","I214","R4182","R413","D120","D122","D124","D125","K3189","R1310","N481","F0390","U071","Z0000","N4889","R339","Z4542","I129","G3184","N179","J90","J9811"],"date":["2025-08-06","2024-05-16","2023-04-13","2024-05-16","2023-04-13","2023-04-13","2026-02-28","2023-04-19","2025-11-17","2023-10-17","2023-10-17","2023-10-17","2025-12-18","2024-05-16","2024-05-16","2024-05-16","2024-01-03","2024-01-03","2024-01-16","2024-01-30","2024-05-16","2024-05-16","2024-05-16","2025-09-24","2025-09-30","2025-11-24","2025-09-23","2024-10-15","2025-05-21","2025-07-25","2025-07-25","2025-09-23","2024-11-19","2024-11-19","2025-10-17","2025-10-17","2025-11-12","2026-01-27","2024-12-10","2025-11-18","2025-10-10","2025-10-10","2025-05-01","2025-07-17","2025-10-10","2025-10-10","2024-08-10","2025-07-25","2025-07-28","2025-05-21","2025-05-21","2025-05-21","2025-05-21","2025-05-21","2025-08-27","2024-11-25","2025-07-25","2025-01-28","2025-08-22","2024-11-25","2025-11-17","2025-06-04","2025-09-27","2026-01-28","2024-08-09","2024-08-08","2024-08-08"],"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":[["","","TROSPIUM","60 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Taro","","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Perrigo","","","Select","Select",""],["","","OXYBUTYNIN","5 MG","","Select","Select",""],["","","ALBUTEROL\/IPRATROPIUM","3\/0.5 MG\/3","","Select","Select",""],["","","ROSUVASTATIN","20 MG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","CARVEDILOL","6.25 MG","","Select","Select",""],["","","TRAZODONE","100 MG","","Select","Select",""],["","","Mupirocin 2 % Ointment Glenmark","","","Select","Select",""],["","","AMLODIPINE","10 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","DONEPEZIL","5 MG","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","Betamethasone Diprop 0.05 % Lotion G&W","","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","Azelastine 0.1%","137 MCG","","Select","Select",""],["","","Duloxetine","60 MG","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","FINASTERIDE","5 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","MIRTAZAPINE","30 MG","","Select","Select",""],["","","LOSARTAN","50 MG","","Select","Select",""],["","","Timolol Mal (Twice Daily) 0.5 % Ophth Sol","","","Select","Select",""],["","","MEROPENEM","","","Select","Select",""],["","","BREZTRI AEROSPHERE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","FAMOTIDINE","40 MG","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","STIOLTO RESPIMAT","","","Select","Select",""],["","","AZELASTINE (","0.1%) 137","","Select","Select",""],["","","TIMOLOL MAL (TWICE DAILY)","0.005","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.001","","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":""}]}]}