{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Wayne K Dennison","gend":0,"currentgend":"","add":"246 AUBURN ST APT 55","city":"Portland","state":"ME","zip":"04103","dob":"1946-03-28","age":"","mstatus":"","insh":"10000028514","cliId":"","pno":"2077975675","cno":"","email":"decline@02042026.com","ename":"","eno":"","pphy":"BOUCHARD, MARK P","ppno":"2077811500","pcpadd":"301C US ROUTE 1,","pcpcity":"SCARBOROUGH","pcpstate":"ME","pcpzip":"40749701","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 1113","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04104","pcpfaxno":"2077811507","pcpnpi":"1023040656","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5PT2YE3WT87","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E538","N1832","I10","N200","K7030","D708","R5383","M48062","M47816","M5450","E209","G8929","Z9181","M6281","F320","Z23","E1142","Z0000","G3184","E1122","I509","R600","Z0101","I351","I517","R471","D61818","R29810","R2689","R29818","R4781","I6523","I639","E1165","R262","K7460","E119","N189","I69122","I8510","I952","I69151","D696","N2581","K8020","N281","Z8673","N1831","H2511","R413","I6990","G629","L602","R270","R454","A000","M25511","S4991XA","R2681","S42254A","S42294D","M25519","M160","S0990XA","R296","S299XXA","S62114A","W19XXXA","Y92009","S6991XA","M7989","I5032","S62114D","Z86010","K921","R300","D649","H01112","G251","F01A0","L89322","D500","K7682","Z0100","F01B3","R404","S31829A","Z09","W19XXXD","F01A3","R0682","K766","F0390","M25531","E039","G9340","G928","R350","R55","R399","N3281","R351","M19011","M1711","M75101","M12811","G4700","S42001A","G40909","K7581","K5730","R188","S42014A","S2232XA","I864","S20211A","S7001XA","M47812","G3189","R4182","I69398","T59891A"],"date":["2026-02-09","2026-02-09","2023-10-30","2023-10-30","2025-09-03","2023-04-28","2023-04-28","2023-05-22","2024-03-21","2024-03-12","2023-05-22","2023-06-23","2025-03-21","2023-06-23","2023-08-01","2025-09-17","2024-05-22","2025-09-30","2024-02-28","2024-07-29","2023-09-29","2023-09-29","2023-08-29","2023-09-29","2023-09-29","2023-10-02","2024-11-11","2023-09-30","2023-12-19","2023-09-29","2025-03-13","2023-09-29","2023-10-10","2023-10-10","2023-10-10","2026-02-09","2023-11-27","2023-10-09","2023-11-17","2024-10-31","2023-09-29","2024-11-20","2023-10-17","2024-04-22","2025-09-03","2025-09-03","2023-11-07","2024-07-29","2023-12-14","2023-11-29","2023-12-19","2023-12-19","2023-10-06","2023-10-06","2023-12-27","2025-12-01","2025-12-10","2024-03-19","2025-03-15","2024-12-05","2024-04-01","2024-03-08","2024-03-12","2024-03-19","2025-03-13","2025-11-25","2024-04-01","2024-03-23","2025-11-04","2025-07-07","2024-03-19","2025-03-13","2024-05-06","2024-04-25","2024-04-21","2024-04-23","2025-10-08","2024-03-24","2024-05-22","2024-10-07","2025-12-01","2025-09-30","2025-04-26","2025-09-16","2026-02-04","2026-02-16","2024-10-18","2025-11-04","2025-11-04","2025-06-10","2024-10-26","2024-10-31","2026-02-17","2025-07-07","2025-09-30","2024-10-26","2025-03-15","2025-05-06","2025-10-11","2025-12-15","2025-12-15","2025-12-15","2025-12-10","2024-10-26","2025-12-10","2025-12-10","2025-03-21","2025-11-06","2025-10-11","2025-06-16","2024-12-17","2025-03-15","2025-11-02","2025-11-25","2024-08-15","2025-11-02","2025-11-02","2025-11-02","2025-11-02","2025-03-13","2024-10-27","2025-03-15"],"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":[["","","MYRBETRIQ","","","Select","Select",""],["","","NITROFURANTOIN MACRO\/MONO","100 MG","","Select","Select",""],["","","SIMVASTATIN","10 MG","","Select","Select",""],["","","NADOLOL","20 MG","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Pacific","","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","LISINOPRIL","40 MG","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","TAMSULOSIN","0.4 MG","","Select","Select",""],["","","CONSTULOSE","","","Select","Select",""],["","","MEMANTINE","5 MG","","Select","Select",""],["","","LACTULOSE","10 GM\/15","","Select","Select",""],["","","PREGABALIN","50 MG","","Select","Select",""],["","","XIFAXAN","","","Select","Select",""],["","","DONEPEZIL","5 MG","","Select","Select",""],["","","LEVOTHYROXINE","50 MCG","","Select","Select",""],["","","RIFAMPIN","300 MG","","Select","Select",""],["","","Difluprednate 0.05 % Ophth Emuls Amneal","","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","ALLOPURINOL","100 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25 MG","","Select","Select",""],["","","SERTRALINE","25 MG","","Select","Select",""],["","","Moxifloxacin 0.5 % Ophth Sol Northstar","","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","DIFLUPREDNATE","0.0005","","Select","Select",""],["","","PREDNISOLONE ACE","0.01","","Select","Select",""],["","","METFORMIN","","","Select","Select",""],["","","POLYMYX\/TRIMETHOPRIM","","","Select","Select",""],["","","MOXIFLOXACIN","0.005","","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":""}]}]}