{
    "version": "0.4",
    "data": [
        {
            "t": "Demographics",
            "q": [
                {
                    "name": "Richard H Freeman",
                    "gend": 0,
                    "currentgend": "",
                    "add": "152 WINTHROP ST",
                    "city": "HALLOWELL",
                    "state": "ME",
                    "zip": "04347",
                    "dob": "1944-12-14",
                    "age": "",
                    "mstatus": "",
                    "insh": "10000015068",
                    "cliId": "",
                    "pno": 2079683004,
                    "cno": "",
                    "email": "declined@070725.com",
                    "ename": "",
                    "eno": "",
                    "pphy": "MILLER, ROY S",
                    "ppno": 2075497581,
                    "pcpadd": "PO BOX 207,",
                    "pcpcity": "COOPERS MILLS",
                    "pcpstate": "ME",
                    "pcpzip": "43410207",
                    "pcpcounty": "",
                    "pcpid": "",
                    "pcpname": "SHEEPSCOT VALLEY HEALTH CENTER",
                    "plan": "Martin's Point",
                    "program": "Medicare",
                    "lob": "GA - 2026",
                    "region": "",
                    "aligned": "",
                    "ano": "",
                    "add2": "",
                    "add3": "",
                    "madd1": "MELISSA NIMON 225 WATERVILLE RD",
                    "madd2": "",
                    "madd3": "",
                    "mcity": "CHINA",
                    "mstate": "ME",
                    "mzip": "04358",
                    "pcpfaxno": "",
                    "pcpnpi": 1700854361,
                    "currentgendcomment": "",
                    "pphycomment": "",
                    "uniqueid": "",
                    "medicareid": "5UJ3NX1RE09",
                    "medicaidid": "",
                    "pcpFlag": ""
                },
                {
                    "a": {
                        "indx": [
                            "",
                            "",
                            "",
                            "",
                            "",
                            "",
                            "",
                            "1"
                        ],
                        "comment": [
                            "",
                            "",
                            "",
                            "",
                            "",
                            "",
                            "",
                            ""
                        ],
                        "sub": {
                            "indx": [
                                [
                                    "No Ethnicity"
                                ]
                            ],
                            "comment": [
                                [
                                    ""
                                ]
                            ],
                            "sub": []
                        }
                    }
                },
                {
                    "a": []
                },
                {
                    "a": []
                },
                {
                    "a": []
                },
                {
                    "a": []
                }
            ]
        },
        {
            "t": "Previously Documented Conditions",
            "q": [
                {
                    "a": {
                        "diag": [
                            "B351",
                            "E11311",
                            "M79671",
                            "I739",
                            "E1142",
                            "M79672",
                            "E1159",
                            "M79674",
                            "L602",
                            "J449",
                            "Z7189",
                            "J439",
                            "M818",
                            "C649",
                            "E119",
                            "Z0000",
                            "J441",
                            "M810",
                            "F419",
                            "R7309",
                            "R5383",
                            "I517",
                            "S0003XA",
                            "R42",
                            "R220",
                            "H0101A",
                            "H0101B",
                            "H04123",
                            "S0081XA",
                            "Z87891",
                            "Z7951",
                            "K5900",
                            "I080",
                            "I2720",
                            "I509",
                            "R1084",
                            "R0689",
                            "R531",
                            "H26493",
                            "H524",
                            "S0990XA",
                            "W19XXXA",
                            "S0031XA",
                            "W1830XA",
                            "W228XXA",
                            "R0600",
                            "S199XXA",
                            "M50323",
                            "M47812",
                            "J9811",
                            "M7989",
                            "R062",
                            "S81801A",
                            "J479",
                            "I10",
                            "R918",
                            "I2510",
                            "J90",
                            "R0989",
                            "R0602",
                            "Z1152",
                            "H26491",
                            "J189",
                            "J9601",
                            "J440",
                            "N179",
                            "E8341",
                            "L603",
                            "R262",
                            "Z0101",
                            "H26492",
                            "R748",
                            "Z0389"
                        ],
                        "date": [
                            "2026-01-14",
                            "2025-09-03",
                            "2026-01-14",
                            "2026-01-14",
                            "2025-07-02",
                            "2026-01-14",
                            "2024-03-13",
                            "2024-03-13",
                            "2024-03-13",
                            "2026-02-08",
                            "2026-02-03",
                            "2025-08-05",
                            "2025-08-05",
                            "2025-08-05",
                            "2026-02-03",
                            "2023-06-09",
                            "2026-02-03",
                            "2026-02-03",
                            "2025-12-23",
                            "2025-02-28",
                            "2023-10-03",
                            "2024-09-12",
                            "2023-10-03",
                            "2023-10-03",
                            "2023-10-03",
                            "2024-03-26",
                            "2024-03-26",
                            "2024-03-26",
                            "2023-10-03",
                            "2024-10-02",
                            "2024-10-02",
                            "2024-05-05",
                            "2024-09-11",
                            "2024-09-11",
                            "2024-09-11",
                            "2024-03-18",
                            "2024-09-09",
                            "2024-03-08",
                            "2024-01-29",
                            "2024-01-29",
                            "2023-10-03",
                            "2023-10-03",
                            "2023-10-03",
                            "2023-10-03",
                            "2023-10-03",
                            "2024-09-12",
                            "2023-10-03",
                            "2023-10-03",
                            "2023-10-03",
                            "2024-09-09",
                            "2024-09-09",
                            "2024-09-09",
                            "2024-09-26",
                            "2024-12-06",
                            "2024-09-09",
                            "2024-12-06",
                            "2024-12-06",
                            "2024-05-06",
                            "2024-05-06",
                            "2024-05-06",
                            "2024-05-05",
                            "2023-12-06",
                            "2024-05-07",
                            "2024-05-07",
                            "2024-05-07",
                            "2024-05-16",
                            "2024-05-16",
                            "2024-07-05",
                            "2025-01-29",
                            "2025-02-20",
                            "2023-11-21",
                            "2023-02-21",
                            "2023-02-21"
                        ],
                        "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": [
                            [
                                "",
                                "",
                                "ALENDRONATE",
                                "70 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "ATORVASTATIN",
                                "40 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "FLUOXETINE",
                                "40 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "METOPROLOL TART",
                                "25 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "IVERMECTIN",
                                "3 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "Bd Autoshield Duo (Ref 329515)",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "OMEPRAZOLE",
                                "40 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "TAMSULOSIN",
                                "0.4 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "TRESIBA FLEXTOUCH",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "Spikevax 2023-2024",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "Fluad Quad 2023-2024",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "MECLIZINE",
                                "25 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "ASSURE PRISM MULTI-TEST STRIPS",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "PAXLOVID",
                                "300\/100 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "ALBUTEROL HFA",
                                "90 MCG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "Prodigy No Coding (Ref 72500)",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "CONTROL SOLUTION",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "PRODIGY CONTROL SOLUTION",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "Unistik 3 Comfort (Ref At 1042)",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "ONDANSETRON",
                                "4 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "ASSURE PRISM",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "TRULICITY",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "GLIPIZIDE",
                                "5 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "ADVAIR HFA",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "FLUTICASONE PROP",
                                "50 MCG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "XDEMVY",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "SPIRIVA RESPIMAT",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "Clobetasol\/Emollient 0.05 % Cream Taro",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "INCRUSE ELLIPTA",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "AREXVY",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "Albuterol 0.083%",
                                "2.5 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "FLUTICASONE PROP\/SALMETEROL",
                                "250\/50 MCG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "WIXELA INHUB",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "CEFPODOXIME",
                                "200 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "AZITHROMYCIN",
                                "250 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "SULFAMETHOXAZOLE\/TRIMETHOPRIM",
                                "800\/160 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "PREDNISONE",
                                "10 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "SPIKEVAX",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "FLUAD",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "Autoshield Duo Diabetic Safety (Ref 329515",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "EASY TOUCH SAFETY",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "ONETOUCH VERIO",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "LEVOFLOXACIN",
                                "750 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "ONETOUCH VERIO FLEX SYSTEM",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "LORAZEPAM",
                                "0.5 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "NYSTOP",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "Trelegy Ellipta",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "Morphine Conc",
                                "100 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "Doxycycline Hyclate",
                                "100 MG",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "Nystatin 100",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "CLOBETASOL\/EMOLLIENT",
                                "0.0005",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "ALBUTEROL (",
                                "0.083%) 2.5",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "AUTOSHIELD DUO DIABETIC SAFETY (REF",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "FLUAD QUAD",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "NYSTATIN",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "PRODIGY NO CODING (REF",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "BD AUTOSHIELD DUO (REF",
                                "",
                                "",
                                "Select",
                                "Select",
                                ""
                            ],
                            [
                                "",
                                "",
                                "UNISTIK",
                                "3 COMFORT",
                                "",
                                "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": ""
                }
            ]
        }
    ]
}