{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"George D Cabot","gend":0,"currentgend":"","add":"582 RIVER RD","city":"Brunswick","state":"ME","zip":"04011","dob":"1939-03-16","age":"","mstatus":"","insh":"10000023794","cliId":"","pno":"2077252166","cno":"","email":"","ename":"","eno":"","pphy":"DAVIS, SARAH M","ppno":"","pcpadd":"MaineHealth Primary Care Family Medicine,329 Maine St Ste A200","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"582 RIVER RD","madd2":"","madd3":"","mcity":"Brunswick","mstate":"ME","mzip":"04011","pcpfaxno":"2076185688","pcpnpi":"1003891177","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9TE2A98JN82","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":["G4731","I10","E6601","Z6839","H401133","H353131","I4821","Z23","N401","N393","R350","H903","R109","R112","G4739","H353221","R0602","I509","I4891","J9811","J90","R0600","I700","I517","I77810","N281","K7689","R140","I5031","I082","I5040","I2720","H26491","Z0000","Z741","I4811","H353222","H401123","H02421","I5021","I110","I5032","H04123","N138","I7121","I422","I358","G4733"],"date":["2026-01-26","2025-11-10","2025-11-10","2023-04-10","2026-01-28","2024-11-15","2023-11-16","2024-12-27","2025-02-11","2025-02-11","2025-02-11","2024-05-24","2025-10-05","2025-10-04","2025-11-10","2026-02-25","2025-03-31","2025-04-03","2025-08-21","2025-03-30","2025-03-30","2025-03-30","2025-03-30","2025-03-30","2025-03-31","2025-03-30","2025-03-30","2025-03-30","2025-03-30","2025-03-31","2025-03-31","2025-03-31","2026-01-28","2024-12-27","2024-12-27","2024-12-27","2025-02-05","2025-02-05","2026-01-28","2025-04-03","2025-03-30","2025-04-16","2024-12-04","2023-02-07","2023-01-24","2023-01-24","2023-01-24","2023-01-23"],"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":[["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","Latanoprost 0.005 % Ophth Sol B&L","","","Select","Select",""],["","","ALFUZOSIN","10 MG","","Select","Select",""],["","","MIRTAZAPINE","15 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Pacific","","","Select","Select",""],["","","Brinzolamide 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","DILTIAZEM","120 MG","","Select","Select",""],["","","Brinzolamide 1 % Ophth Susp Oceanside","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","CAPVAXIVE","","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25 MG","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","POTASSIUM CL","20 MEQ","","Select","Select",""],["","","RHOPRESSA","","","Select","Select",""],["","","COMBIGAN","","","Select","Select",""],["","","FINASTERIDE","5 MG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","BOOSTRIX","","","Select","Select",""],["","","BRINZOLAMIDE","0.01","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","Hydrocodone\/Acetaminophen","5\/325 MG","","Select","Select",""],["","","COLCHICINE","0.6 MG","","Select","Select",""],["","","CARTIA XT","","","Select","Select",""],["","","Latanoprost 0.005 % Ophth Sol Somerset","","","Select","Select",""],["","","Latanoprost 0.005 % Ophth Sol Sandoz","","","Select","Select",""],["","","Latanoprost 0.005 % Ophth Sol Greenstone","","","Select","Select",""],["","","LATANOPROST","0.00005","","Select","Select",""],["","","PREDNISOLONE ACE","0.01","","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":""}]}]}