{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Thomas G Tanguay","gend":0,"currentgend":"","add":"184 WESTBROOK ST","city":"South Portland","state":"ME","zip":"04106","dob":"1944-11-26","age":"","mstatus":"","insh":"10000025068","cliId":"","pno":"2077749727","cno":"","email":"mimitpapat@aol.com","ename":"","eno":"","pphy":"WOOD, BEVERLY J","ppno":"","pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE SOUTH PORTLAND","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"184 WESTBROOK ST","madd2":"","madd3":"","mcity":"South Portland","mstate":"ME","mzip":"04106","pcpfaxno":"2078287850","pcpnpi":"1922071349","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6JK6PA5RA47","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I83028","L97829","G629","L819","I87312","I890","L97922","B351","R262","E1159","E1142","E1149","T8189XD","I83029","L97929","E1140","L989","L570","Z85828","L130","M1712","E11649","E669","M5136","R600","I83022","L97222","E119","M4306","M5450","M5416","M170","Z0189","M48062","M1711","L97821","L97822","M25561","M25562","M6281","I872","L97329","M5126","M47896","M5459","M47817","M7121","Z0000","M7989","I10","Z87891","E785","M19072","E11622","T8189XA","F413","E559","R5383","E11621","M79604"],"date":["2024-07-02","2024-04-09","2023-07-11","2023-04-14","2024-06-25","2024-02-20","2023-04-11","2024-06-03","2024-06-03","2024-06-03","2024-06-03","2024-06-03","2024-03-05","2023-08-29","2023-08-29","2024-07-02","2023-08-15","2024-02-06","2024-02-06","2024-02-06","2023-11-07","2023-08-18","2023-08-18","2023-08-18","2024-07-02","2023-12-19","2023-09-26","2023-09-19","2023-11-07","2024-02-22","2023-09-27","2023-11-28","2023-09-27","2023-11-07","2023-09-27","2024-07-02","2024-05-28","2024-03-05","2024-03-05","2024-03-05","2023-11-15","2023-11-15","2023-11-22","2023-11-28","2024-02-29","2024-03-06","2024-06-18","2023-09-18","2024-06-18","2024-07-05","2023-12-14","2023-12-15","2024-01-16","2024-06-11","2024-02-06","2023-12-15","2023-12-15","2023-12-15","2024-04-09","2024-06-18"],"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":[["","","Mupirocin 2 % Ointment Padagis","","","Select","Select",""],["","","Amitriptyline","25 MG","","Select","Select",""],["","","Lisinopril","10 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Atorvastatin","80 MG","","Select","Select",""],["","","Esomeprazole Mag","40 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 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":""}]}]}