{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jerome R Dumont","gend":0,"currentgend":"","add":"40D ATWOOD RD","city":"Topsham","state":"ME","zip":"04086","dob":"1951-05-09","age":"","mstatus":"","insh":"10000023657","cliId":"","pno":"2075221008","cno":"","email":"Harpoon8131@hotmail.com","ename":"","eno":"","pphy":"GARDINER, PAMELA A","ppno":"2077984050","pcpadd":"Martins Point Healthcare,74 Baribeau Dr","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"40D ATWOOD RD","madd2":"","madd3":"","mcity":"Topsham","mstate":"ME","mzip":"04086","pcpfaxno":"2078287850","pcpnpi":"1023030020","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4EC0CX9HF34","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R778","E119","E1136","I2510","R5383","Z0101","H25813","E113291","I4819","I420","I10","Z950","Z45018","M353","M4819","E559","E785","E0590","Z125","Z79899","M2550","Z23","M0579","K047","E1342","R7989","M25511","M19011","K029","M19012","M25512","R600","D72829","R7401","I447","J449","F418","M1611","M25551","M47816","L282","B356","R5381","E876","E1336","M059","Z8639","I4891","Z87891","J984","E1165","E041","K011","E042","Z7952","Z7961","Z79620"],"date":["2023-04-17","2023-09-14","2025-05-28","2024-12-10","2023-04-25","2025-12-16","2025-12-16","2025-12-16","2024-12-10","2024-12-10","2024-12-10","2026-02-19","2023-11-13","2023-05-11","2024-04-08","2025-11-14","2025-11-14","2023-09-14","2023-09-14","2026-02-03","2023-09-14","2023-09-18","2025-12-18","2024-03-01","2025-02-26","2024-04-08","2024-05-18","2024-07-02","2025-05-23","2025-07-23","2025-07-23","2024-09-24","2024-09-24","2024-09-24","2025-05-23","2025-05-23","2025-05-23","2025-07-23","2025-07-23","2025-07-23","2026-02-24","2026-02-24","2024-10-04","2024-11-11","2024-11-11","2024-12-23","2025-12-12","2025-11-18","2025-12-30","2025-12-30","2025-11-14","2025-12-12","2025-05-23","2025-12-12","2025-12-18","2025-11-06","2024-10-30"],"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",""],["","","Triamcinolone Acet 0.1 % Cream Taro","","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","Ketoconazole 2 % Cream Encube","","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","ATORVASTATIN","40 MG","","Select","Select",""],["","","Freestyle Libre 3 Sensor Plus","","","Select","Select",""],["","","Novolin 70\/30 Flexpen","","","Select","Select",""],["","","METHYLPREDNISOLONE","4 MG","","Select","Select",""],["","","METOPROLOL SUCC","50 MG","","Select","Select",""],["","","LAMOTRIGINE","25 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","LEFLUNOMIDE","10 MG","","Select","Select",""],["","","Lantus Solostar","","","Select","Select",""],["","","SULFASALAZINE","500 MG","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","TORSEMIDE","20 MG","","Select","Select",""],["","","POTASSIUM CL","20 MEQ","","Select","Select",""],["","","OXYCODONE HCL","10 MG","","Select","Select",""],["","","BASAGLAR KWIKPEN","","","Select","Select",""],["","","KWIKPEN","","","Select","Select",""],["","","SPIRONOLACTONE","25 MG","","Select","Select",""],["","","Lidocaine 5 % Ointment Taro","","","Select","Select",""],["","","OXYCONTIN","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","HYDROCODONE\/ACETAMINOPHEN","5\/325 MG","","Select","Select",""],["","","Freestyle Libre 3 Sensor","","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","HUMIRA PEN","","","Select","Select",""],["","","Ketoconazole 2 % Shampoo Padagis","","","Select","Select",""],["","","Fluconazole","150 MG","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","Nystatin 100","","","Select","Select",""],["","","NOVOLIN","","","Select","Select",""],["","","FREESTYLE LIBRE","3 SENSOR","","Select","Select",""],["","","KETOCONAZOLE","0.02","","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":""}]}]}