{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Peter Small","gend":0,"currentgend":"","add":"56 RACHEL BLVD","city":"Lewiston","state":"ME","zip":"04240","dob":"1947-05-20","age":"","mstatus":"","insh":"10000017841","cliId":"","pno":"2077847544","cno":"","email":"dsmallpete@aol.com","ename":"","eno":"","pphy":"DUQUETTE, ADAM","ppno":"2077847388","pcpadd":"190 STETSON RD,","pcpcity":"AUBURN","pcpstate":"ME","pcpzip":"42107813","pcpcounty":"","pcpid":"","pcpname":"FAMILY HEALTH CARE ASSOCIATES","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"2076507079","add2":"","add3":"","madd1":"56 RACHEL BLVD","madd2":"","madd3":"","mcity":"Lewiston","mstate":"ME","mzip":"04240","pcpfaxno":"2077952043","pcpnpi":"1679884522","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8F57MT2XF77","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M9904","M5137","M47817","M9903","G250","Z0000","E663","E039","E785","L718","L570","X32XXXA","L814","L821","Z08","Z85828","D485","C44519","E119","I10","G500","R2689","C679","Z510","C675","Z5111","R944","R319","R399","N400","R309","C678","N3000","N3090","C672","C775","Z452","R350","N3289","K769","N200","N1330","E8342","R351","K5900","I82409","I82411","I82431","R338","E113293","Z79899","Z01818","C44619","L905"],"date":["2024-08-14","2024-08-14","2024-08-14","2024-08-14","2023-05-16","2025-09-12","2024-08-29","2023-11-17","2024-02-14","2023-06-02","2025-09-18","2024-09-12","2025-09-18","2025-09-18","2025-09-18","2025-09-18","2025-09-18","2023-09-05","2025-07-08","2024-11-19","2026-02-11","2024-08-05","2025-12-09","2025-07-01","2026-02-04","2025-07-10","2025-06-13","2025-02-06","2025-01-15","2025-12-04","2025-01-15","2025-03-28","2025-09-17","2025-09-03","2025-07-08","2025-07-08","2025-04-09","2025-07-01","2025-03-03","2025-02-06","2025-02-06","2025-03-28","2025-06-18","2024-12-27","2024-12-13","2025-08-29","2025-08-22","2025-08-22","2026-03-01","2025-07-08","2025-04-17","2025-02-24","2023-03-02","2023-03-02"],"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":[["","","ATORVASTATIN","10 MG","","Select","Select",""],["","","CARBAMAZEPINE","100 MG","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","TAMSULOSIN","0.4 MG","","Select","Select",""],["","","OXYBUTYNIN","5 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","METRONIDAZOLE","0.0075","","Select","Select",""],["","","AMLODIPINE","2.5 MG","","Select","Select",""],["","","Oxycodone Hcl\/Acetaminophen","5\/325 MG","","Select","Select",""],["","","ONDANSETRON","8 MG","","Select","Select",""],["","","Metronidazole 0.75 % Lotion Fougera","","","Select","Select",""],["","","PROCHLORPERAZINE","10 MG","","Select","Select",""],["","","LISINOPRIL","40 MG","","Select","Select",""],["","","HYDROCODONE\/ACETAMINOPHEN","5\/325 MG","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","LEVOTHYROXINE","75 MCG","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","CIPROFLOXACIN","500 MG","","Select","Select",""],["","","Metformin 1","","","Select","Select",""],["","","FLUAD QUAD","","","Select","Select",""],["","","METFORMIN","","","Select","Select",""],["","","SPIKEVAX","","","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":""}]}]}