{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Wayne Paul","gend":0,"currentgend":"","add":"181 MAIN RD N","city":"FRANKFORT","state":"ME","zip":"04438","dob":"1948-01-06","age":"","mstatus":"","insh":"10000021549","cliId":"","pno":"2073384132","cno":"2073227097","email":"wpaul408@gmail.com","ename":"","eno":"","pphy":"LANG, DAPHNE C","ppno":"2075674000","pcpadd":"Stockton Springs Regional Health Center,11 Cape Jellison Rd","pcpcity":"Stockton Springs","pcpstate":"ME","pcpzip":"04981","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"2073384132","add2":"","add3":"","madd1":"181 MAIN RD N","madd2":"","madd3":"","mcity":"FRANKFORT","mstate":"ME","mzip":"04438","pcpfaxno":"","pcpnpi":"1730592205","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4PW6H55TW63","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z7901","M19011","Z01812","M25411","I4820","E669","G4700","R5383","F1010","E785","N1831","I2510","Z471","G8918","I4891","I4510","Z96611","R911","R059","R053","I340","I083","I2720","I77810","R9439","I493","E871","Z951","E781","I509","Z0100","I10","E806","I4819","I5023","I110","I25118","L03115","Z4800","I088","I5022","I25810","R931","I5033","R9389","K8590","R0602","I081","H25813","H43813","S81801D","J929","R918","N2889","I480","Z23","R042","I87333","K869","I517","S81811A","J90","S40862A","N281","I5020","I87331","Z0000","J329","R0683","I4821","K8520","J40","I351","J984"],"date":["2025-03-04","2023-10-19","2023-07-21","2023-08-10","2024-11-18","2023-09-21","2023-09-21","2023-09-21","2023-09-21","2023-09-21","2023-09-21","2025-06-05","2024-10-18","2023-10-19","2025-11-26","2024-02-02","2025-03-17","2024-09-10","2024-09-18","2023-12-08","2023-12-29","2024-09-25","2024-10-24","2023-12-18","2024-02-27","2024-12-03","2024-02-27","2024-02-19","2024-03-25","2024-09-23","2025-11-18","2024-11-14","2024-05-06","2025-12-05","2025-01-30","2024-10-25","2025-10-22","2025-07-23","2025-10-03","2024-09-03","2025-11-18","2024-10-24","2024-10-24","2024-10-26","2025-04-28","2024-09-11","2024-09-10","2025-02-06","2026-01-13","2026-01-13","2025-07-24","2025-05-06","2025-05-06","2025-05-06","2025-12-26","2025-01-30","2025-03-17","2025-10-03","2025-02-07","2024-09-03","2025-07-14","2024-09-10","2025-05-10","2024-08-19","2024-09-25","2025-09-26","2025-07-31","2026-01-27","2025-04-11","2025-02-27","2024-08-16","2025-03-17","2024-09-11","2025-04-28"],"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":[["","","ENTRESTO","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","FLUTICASONE PROP","50 MCG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","SACUBITRIL\/VALSARTAN","49\/51 MG","","Select","Select",""],["","","AMIODARONE","200 MG","","Select","Select",""],["","","ALLOPURINOL","300 MG","","Select","Select",""],["","","ENOXAPARIN SODIUM","","","Select","Select",""],["","","SPIRONOLACTONE","25 MG","","Select","Select",""],["","","Ezetimibe","10 MG","","Select","Select",""],["","","ENOXAPARIN PF","100 MG\/ML","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","ENALAPRIL","20 MG","","Select","Select",""],["","","LISINOPRIL","2.5 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","Isosorbide Mononitrate","30 MG","","Select","Select",""],["","","Metoprolol Succ","25 MG","","Select","Select",""],["","","CHLORTHALIDONE","25 MG","","Select","Select",""],["","","ROSUVASTATIN","20 MG","","Select","Select",""],["","","TORSEMIDE","20 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","NITROGLYCERIN","0.4 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","PREDNISONE","20 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":""}]}]}