{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michael Leblanc","gend":0,"currentgend":"","add":"357 MCCRILLIS RD","city":"EAST WILTON","state":"ME","zip":"04234","dob":"1948-07-27","age":"","mstatus":"","insh":"10000025903","cliId":"","pno":"2077782685","cno":"2074910792","email":"mike.leblanc@mac.com","ename":"","eno":"","pphy":"SAGE, JOLINE A","ppno":"2075624226","pcpadd":"16 DEPOT ST SUITE 300,","pcpcity":"LIVERMORE FALLS","pcpstate":"ME","pcpzip":"04254","pcpcounty":"","pcpid":"","pcpname":"WESTERN MAINE FAMILY HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 273","madd2":"","madd3":"","mcity":"4234","mstate":"ME","mzip":"04234","pcpfaxno":"2078972321","pcpnpi":"1285038174","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7X56A21XF88","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":["S8261XS","S82891A","S8261XA","M25471","M25571","S8264XA","S82434A","M7731","S82451S","S89301G","C61","S8261XG","G8918","G4730","Z9989","I10","Z79899","S8261XD","N401","N138","Z98890","M8440XA","S62329B","Z79818","B351","M79671","M79672","S82401D","Z0101","H5203","H353123","H25813","D3131","G4733","C775","Z510","H6090","H608X2","B369","Z0189","M19071","S82401A","R059","R0600","H2512","H2511","H5703","Z0000","I498","I739","M79675","M79674","I7389","L989","H1131","H04123","H6122","H918X3","R200","C3412","H6991","Z87891","L570","X32XXXA","D485","L821","L814","H61302","R001","C44529","C44219","I491","H90A21","H90A32","Z1211","S82431A","R9431","Z136","Z23","D649","L851","C637","Z01818","R339"],"date":["2023-04-14","2023-04-06","2023-06-12","2023-04-06","2025-03-19","2023-05-01","2023-05-25","2023-11-29","2023-04-06","2023-04-06","2026-02-12","2023-04-13","2023-04-14","2023-04-14","2023-04-14","2023-04-25","2024-10-07","2023-05-10","2025-08-05","2025-08-05","2023-11-29","2023-06-12","2023-06-12","2023-08-01","2025-08-18","2025-03-18","2025-03-18","2023-07-06","2025-03-19","2025-03-19","2025-09-22","2023-07-18","2025-09-22","2025-02-10","2023-09-07","2023-09-19","2023-09-11","2023-08-28","2023-08-28","2023-09-07","2025-03-19","2025-03-19","2023-12-28","2023-12-28","2024-02-13","2024-02-20","2024-02-20","2026-03-09","2024-04-25","2025-06-03","2025-08-18","2025-08-18","2025-08-18","2025-07-03","2024-09-23","2024-09-23","2025-09-23","2026-01-21","2026-02-09","2026-03-04","2026-01-21","2026-01-21","2025-06-25","2025-06-25","2025-06-25","2025-06-25","2025-06-25","2026-02-24","2024-10-07","2025-07-03","2025-07-03","2026-02-09","2025-11-21","2025-11-21","2025-11-12","2023-03-27","2024-07-15","2024-07-15","2025-03-05","2025-03-10","2023-03-15","2023-02-08","2023-02-20","2023-02-10"],"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":[["","","PREDNISONE","5 MG","","Select","Select",""],["","","ATENOLOL","50 MG","","Select","Select",""],["","","ABIRATERONE","500 MG","","Select","Select",""],["","","Ciproflox\/Dexameth 0.3\/0.1 % Otic Susp Amn","","","Select","Select",""],["","","FLUZONE HIGH-DOSE","","","Select","Select",""],["","","Ciproflox\/Dexameth 0.3\/0.1 % Otic Susp San","","","Select","Select",""],["","","EPINEPHRINE","0.3 MG","","Select","Select",""],["","","Ciproflox\/Dexameth 0.3\/0.1 % Otic Susp Sun","","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","AMLODIPINE","5 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","Chlorhexidine 0.12 % Oral Rinse Xttrium","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","Doxazosin","4 MG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","LISINOPRIL","40 MG","","Select","Select",""],["","","SIMVASTATIN","20 MG","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25 MG","","Select","Select",""],["","","Lorazepam","0.5 MG","","Select","Select",""],["","","Ciproflox\/Dexameth 0.3\/0.1 % Otic Susp Dr","","","Select","Select",""],["","","ABIRATERONE ACETATE","","","Select","Select",""],["","","FLUAD QUAD","","","Select","Select",""],["","","CIPROFLOX\/DEXAMETH","0.3\/0.1 %","","Select","Select",""],["","","PREDNISOLONE ACE","0.01","","Select","Select",""],["","","CHLORHEXIDINE","0.0012","","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":""}]}]}