{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donald C Roffey","gend":0,"currentgend":"","add":"922 OHIO ST APT 105","city":"Bangor","state":"ME","zip":"04401","dob":"1948-01-30","age":"","mstatus":"","insh":"10000028365","cliId":"","pno":"2072147779","cno":"2072147779","email":"derof7071@gmail.com","ename":"","eno":"","pphy":"RIKER, KERRY S","ppno":"2079073300","pcpadd":"St Joseph Internal Medicine,900 Broadway Bldg 5","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"2078849001","add2":"","add3":"","madd1":"922 OHIO ST APT 105","madd2":"","madd3":"","mcity":"Bangor","mstate":"ME","mzip":"04401","pcpfaxno":"2079071923","pcpnpi":"1033199591","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8YW2T44NW22","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J449","Z0000","Z87891","E669","N400","E785","M25551","M25561","R296","B351","R262","R55","M1611","I77810","R42","L821","L814","Z7189","Z122","I6523","I517","G4733","R0683","R911","J4520","R000","Z01812","Z0101","H40013","Z471","Z96641","J069","J209","Z20822","R062","J40","R059","R079","Z09","J441","I4510","E6601","Z6841","L720","L570"],"date":["2023-04-03","2024-07-08","2024-06-12","2023-09-01","2023-04-03","2023-04-06","2023-12-06","2023-04-11","2023-04-12","2024-07-10","2024-07-10","2023-06-08","2023-10-23","2023-05-31","2023-06-01","2024-06-04","2024-06-04","2024-06-04","2023-05-30","2023-06-01","2023-05-31","2024-06-12","2023-06-13","2023-06-13","2024-02-05","2023-06-13","2023-08-02","2023-09-22","2023-09-22","2023-12-07","2024-02-15","2023-11-14","2023-11-27","2023-11-27","2023-11-14","2023-12-16","2023-12-16","2024-02-12","2024-03-01","2024-04-01","2024-02-15","2024-03-01","2024-03-01","2024-06-04","2024-06-04"],"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",""],["","","Losartan","50 MG","","Select","Select",""],["","","Doxycycline Monohydrate","100 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Rosuvastatin","10 MG","","Select","Select",""],["","","Levothyroxine","25 MCG","","Select","Select",""],["","","Montelukast Sodium","","","Select","Select",""],["","","Tamsulosin","0.4 MG","","Select","Select",""],["","","Naproxen","250 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Prednisone","50 MG","","Select","Select",""],["","","Montelukast","10 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":""}]}]}