{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donald Tyrol","gend":0,"currentgend":"","add":"1653 CROSS HILL RD","city":"Vassalboro","state":"ME","zip":"04989","dob":"1946-11-13","age":"","mstatus":"","insh":"10000013261","cliId":"","pno":"2075571146","cno":"","email":"dhtyrol@fairpoint.net","ename":"","eno":"","pphy":"CHAMBERLAIN, DEAN E","ppno":"2074379388","pcpadd":"Lovejoy Health Center,7 School St Ste 1","pcpcity":"Albion","pcpstate":"ME","pcpzip":"04910","pcpcounty":"","pcpid":"","pcpname":"LOVEJOY HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1653 CROSS HILL RD","madd2":"","madd3":"","mcity":"Vassalboro","mstate":"ME","mzip":"04989","pcpfaxno":"2078619624","pcpnpi":"1922360411","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8TA1PA9KT93","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N1831","I10","E782","Z0001","C649","Z08","N401","R351","Z85528","R6889","Z1283","I2510","I4811","E7800","Z0101","R42","I4891","Z7901","R079","H538","Z789","I480","H26491","H26492","I484","C20","C4330","Z48816","Z87891","Z905","I080","N289","D472","N179","C8300","D122","D124","K635","E039","R0609","N281","N400","N2889","I4819","C642","G4733","G8918","N184","I5031","I129","C8800","R0683","Z23","K219","E669","R4182","D649","N1832","C880","Z1211","D1803","R1904","K7689","G4700","Z5111","Z0189","Z7689","C8309","L821","L814","D225","D2271","L570","L820","E854","I43","Z1159","I425","I517","I5189","Z0100","D123","K5730","D127","K648","K6389","L851"],"date":["2023-08-23","2024-08-13","2023-08-23","2025-08-27","2024-10-29","2023-11-01","2023-11-01","2023-11-01","2025-02-24","2023-12-13","2024-03-12","2024-05-30","2024-05-06","2024-03-22","2024-03-07","2024-07-16","2024-04-14","2024-04-14","2024-04-14","2024-04-14","2024-04-14","2026-01-22","2024-05-29","2024-06-12","2024-10-25","2024-10-29","2024-10-14","2025-02-24","2025-02-24","2025-02-24","2024-10-25","2026-02-02","2025-08-08","2024-09-06","2026-01-05","2024-09-03","2024-09-03","2024-09-03","2024-08-19","2024-08-27","2025-08-01","2024-09-06","2026-02-25","2025-12-22","2025-08-01","2026-03-09","2025-01-23","2024-10-04","2024-08-02","2025-07-22","2025-10-06","2025-12-18","2024-12-02","2024-09-30","2024-09-30","2024-09-30","2025-08-07","2024-12-02","2024-09-20","2024-09-03","2024-12-05","2024-12-05","2024-12-05","2025-12-18","2026-01-06","2025-06-16","2026-01-07","2026-02-02","2025-03-26","2025-03-26","2025-03-26","2025-03-26","2025-03-26","2025-03-26","2026-01-22","2026-01-22","2025-08-06","2025-09-15","2025-06-16","2025-06-16","2025-03-11","2023-03-17","2023-03-17","2023-03-17","2023-03-17","2023-03-17","2023-03-08"],"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":[["","","LEVOTHYROXINE","75 MCG","","Select","Select",""],["","","FLUTICASONE PROP","50 MCG","","Select","Select",""],["","","LISINOPRIL","10 MG","","Select","Select",""],["","","PROCHLORPERAZINE","10 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","AMIODARONE","200 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE","","","Select","Select",""],["","","ACYCLOVIR","400 MG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","Peg 3350\/Electrolytes","420 GM","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","ONDANSETRON","8 MG","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","CARVEDILOL","12.5 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25 MG","","Select","Select",""],["","","ROSUVASTATIN","20 MG","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","FAMOTIDINE","40 MG","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","Clobetasol 0.05 % Top Sol Micro Labs","","","Select","Select",""],["","","FLUAD QUAD","","","Select","Select",""],["","","PEG","3350\/ELECTROLYTES 420","","Select","Select",""],["","","CLOBETASOL","0.0005","","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":""}]}]}