{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Walter Dumont","gend":0,"currentgend":"","add":"2 LEDGEMERE LN","city":"LEWISTON","state":"ME","zip":"04240","dob":"1947-06-21","age":"","mstatus":"","insh":"10000017857","cliId":"","pno":"2075762839","cno":"","email":"C.DUMONT7@HOTMAIL.COM","ename":"","eno":"","pphy":"SHEIKH, MUHAMMAD A","ppno":"","pcpadd":"1100 TRANCAS ST STE 256,","pcpcity":"NAPA","pcpstate":"CA","pcpzip":"94558292","pcpcounty":"","pcpid":"","pcpname":"ST MARYS MEDICAL ASSOCIATES","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"2 LEDGEMERE LN","madd2":"","madd3":"","mcity":"LEWISTON","mstate":"ME","mzip":"04240","pcpfaxno":"7072511706","pcpnpi":"1235252859","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1U56J82HK52","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H43823","H16223","H532","H5501","I10","R918","R2681","J189","Z9181","R0602","Z0101","H40013","H903","H6123","R6889","R600","R7303","E782","G4733","Z0000","M5450","M79672","M79671","R112","R29898","R29818","R531","R197","I361","M5117","M4726","I083"],"date":["2024-01-02","2023-04-18","2023-04-18","2023-04-18","2024-04-15","2023-04-24","2023-10-03","2023-05-15","2023-05-01","2023-04-24","2023-06-22","2023-06-22","2023-07-13","2024-02-06","2023-08-17","2024-06-03","2023-10-31","2024-04-06","2024-04-18","2023-10-31","2023-12-21","2023-12-21","2023-12-21","2024-02-01","2024-06-25","2024-03-26","2024-03-26","2024-02-01","2024-06-03","2024-06-25","2024-06-25","2024-06-03"],"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":[["","","Lisinopril\/Hydrochlorothiazide","20\/12.5 MG","","Select","Select",""],["","","Miebo","","","Select","Select",""],["","","Meclizine","12.5 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Rosuvastatin","5 MG","","Select","Select",""],["","","Cyclobenzaprine","5 MG","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Furosemide","20 MG","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 MG","","Select","Select",""],["","","Ozempic","","","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":""}]}]}