{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Richard A Dumont","gend":0,"currentgend":"","add":"24 MARY ST","city":"LEWISTON","state":"ME","zip":"04240","dob":"1946-07-19","age":"","mstatus":"","insh":"10000012648","cliId":"","pno":"2074024116","cno":"2074024116","email":"dbeedsue@aol.com","ename":"","eno":"","pphy":"KAPPELMANN, RICHARD K","ppno":"","pcpadd":"PO BOX 1638,","pcpcity":"ALBANY","pcpstate":"NY","pcpzip":"12201163","pcpcounty":"","pcpid":"","pcpname":"DR RICHARD KAPPELMANN PRACTICE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"24 MARY ST","madd2":"","madd3":"","mcity":"LEWISTON","mstate":"ME","mzip":"04240","pcpfaxno":"2077836660","pcpnpi":"1407881121","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7U77H45UG71","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H6123","L989","H2513","H2511","E785","H9190","H6122","H1132","Z0000","I82402","E7800","I358","D649","Z1211","Z86010","D122","Z96652","Z471","Z1212","K635","L570","L821","B354","R6889","R9720"],"date":["2023-05-03","2023-05-03","2023-05-09","2023-05-16","2023-05-16","2023-06-09","2023-06-09","2023-08-04","2023-08-14","2023-08-14","2023-08-14","2023-08-14","2023-09-06","2023-10-11","2023-10-11","2023-10-11","2023-10-12","2023-10-12","2023-10-11","2023-10-11","2023-10-31","2023-10-31","2023-10-31","2023-12-17","2024-03-19"],"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":[["","","Gavilyte-C","","","Select","Select",""],["","","Xarelto","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Simvastatin","40 MG","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Terbinafine","250 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Fluzone High Dose","","","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":""}]}]}