{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Herby J Clavette","gend":0,"currentgend":"","add":"14 CHRIS AVE","city":"SABATTUS","state":"ME","zip":"04280","dob":"1940-05-03","age":"","mstatus":"","insh":"10000021940","cliId":"","pno":"2073754592","cno":"","email":"","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":"","add2":"","add3":"","madd1":"14 CHRIS AVE","madd2":"","madd3":"","mcity":"SABATTUS","mstate":"ME","mzip":"04280","pcpfaxno":"2077952043","pcpnpi":"1679884522","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7FW0MV1NF49","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R0602","R918","R911","J90","J984","I4891","I5022","Z20822","I5032","I110","E119","I517","R7989","Z87891","I10","L989","R55","I509","R0902","Z043","R930","K921","D62","K269","K922","K222","K449","Z7901","R519","Z09","R350","S0990XA","R109","K6389","W19XXXA","R32","R319","M25512","M19012","S4292XA","S0083XA","W1830XA","I4819","M50323","M50322","J342","D649","N2889","N400","N289","D485","C44311","Z0000","R7303","L570","M6289","Z872","Z08","Z85828","I499","I4821","I340","Z006","D500","C3412","J9601","Z95818","J449","I341","R0600","K6812"],"date":["2024-12-26","2026-02-06","2026-02-24","2024-10-22","2023-06-03","2025-11-25","2023-06-03","2023-06-03","2023-06-05","2025-10-16","2025-12-22","2023-06-05","2023-06-03","2023-06-03","2025-03-20","2023-06-01","2026-02-09","2025-01-01","2025-06-19","2023-06-18","2023-06-18","2023-06-16","2023-07-06","2023-06-16","2023-07-06","2023-06-16","2023-06-16","2024-06-13","2023-06-30","2025-01-06","2024-01-18","2023-08-18","2023-06-30","2023-06-30","2023-06-30","2023-10-24","2024-01-18","2023-08-18","2023-08-18","2023-08-18","2023-08-18","2023-08-18","2024-10-21","2023-08-18","2023-08-18","2023-08-18","2024-12-19","2023-11-07","2023-11-07","2023-11-07","2023-11-30","2024-01-25","2025-12-31","2023-12-13","2024-01-25","2026-02-24","2024-03-28","2024-03-28","2024-03-28","2025-07-15","2024-06-26","2025-11-25","2024-06-26","2023-07-27","2025-05-05","2025-07-06","2026-02-09","2026-02-24","2024-08-14","2025-02-28","2026-02-06"],"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",""],["","","LISINOPRIL","5 MG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","TAMSULOSIN","0.4 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE","","","Select","Select",""],["","","METOPROLOL TART","50 MG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","Anoro Ellipta","","","Select","Select",""],["","","Fluzone High-Dose Quad 2023-24","","","Select","Select",""],["","","Umeclidinium\/Vilanterol","62.5\/25 MCG","","Select","Select",""],["","","METOPROLOL SUCC","50 MG","","Select","Select",""],["","","FLUOROURACIL","0.05","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","Fluorouracil 5 % Cream Taro","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD","","","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":""}]}]}