{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Allen H Bourassa","gend":0,"currentgend":"","add":"154 AUGUSTA RD","city":"Winslow","state":"ME","zip":"04901","dob":"1960-01-05","age":"","mstatus":"","insh":"10000013586","cliId":"","pno":"2076806902","cno":"","email":"ABOURASSA60@GMAIL.COM","ename":"","eno":"","pphy":"PHELPS, JULIE J","ppno":"","pcpadd":"Waterville Family Practice,31 Front St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"WATERVILLE FAMILY PRACTICE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"154 AUGUSTA RD","madd2":"","madd3":"","mcity":"Winslow","mstate":"ME","mzip":"04901","pcpfaxno":"2078731186","pcpnpi":"1679562979","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7UU6EM2UW41","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I2510","R42","I639","I10","Z1283","L570","L814","D2272","E119","E785","I6523","G5602","G5732","E1142","R200","R202","G608","G4733","Z794","D696","Z0000","Z1331","Z23","Z139","B351","B354","H903","D3141","H5213","H52223","H524","H47323","H25093"],"date":["2024-05-31","2023-10-27","2023-04-05","2024-05-31","2024-04-22","2023-10-05","2023-04-10","2023-04-10","2024-05-31","2024-05-31","2023-05-30","2023-06-23","2023-06-12","2023-06-12","2023-06-23","2023-06-23","2023-06-23","2023-07-27","2023-09-27","2023-09-27","2023-09-27","2023-09-27","2023-09-27","2023-09-27","2023-10-05","2023-10-05","2023-10-27","2024-03-21","2024-03-21","2024-03-21","2024-03-21","2024-03-21","2024-03-21"],"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":[["","","Xarelto","","","Select","Select",""],["","","Bd Nano 2 Gen","","","Select","Select",""],["","","Metoprolol Tart","100 MG","","Select","Select",""],["","","Embecta Nano 2Nd Gen (Ref 320550)","","","Select","Select",""],["","","Lisinopril","10 MG","","Select","Select",""],["","","Tresiba Flextouch","","","Select","Select",""],["","","Ketoconazole 2 % Cream Encube","","","Select","Select",""],["","","Atorvastatin","80 MG","","Select","Select",""],["","","Terbinafine","250 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Onetouch Verio","","","Select","Select",""],["","","Clindamycin","150 MG","","Select","Select",""],["","","Onetouch Ultra Blue","","","Select","Select",""],["","","Ozempic","","","Select","Select",""],["","","Lantus Solostar","","","Select","Select",""],["","","Jardiance","","","Select","Select",""],["","","Glipizide","5 MG","","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":""}]}]}