{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert G Allen","gend":0,"currentgend":"","add":"4 BALSAM DR","city":"Topsham","state":"ME","zip":"04086","dob":"1946-01-28","age":"","mstatus":"","insh":"10000028982","cliId":"","pno":"2077259202","cno":"","email":"RGA@KNOXRICKSEN.COM","ename":"","eno":"","pphy":"MESERVE, CHRISTOPHER W","ppno":"2074067600","pcpadd":"Mid Coast Medical Group Topsham Internal Medicine,1 Wellness Way Ste A","pcpcity":"Topsham","pcpstate":"ME","pcpzip":"04086","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"5108472448","add2":"","add3":"","madd1":"4 BALSAM DR","madd2":"","madd3":"","mcity":"Topsham","mstate":"ME","mzip":"04086","pcpfaxno":"2074067601","pcpnpi":"1184713471","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5Y71XR3NE10","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J449","M5136","R059","Z96611","T84498D","Z01818","T84098A","Z96619","K449","K224","L820","R208","Z789","L814","L821","Z08","Z85828","L570","T84498A","E785","G8918","Z471","M25511","Z4789","M25562","Z0000","Z9181","I2510","K219","L853","I7300","G603","B351","M79671","M79672","L858","P800","S838X2A","S83242A","S83232D","M75112","M19012","M25512","Z96612","C44612","C44622","D485","H5005","H25813","R1319","K529","T18128A","W44F3XA","M1712","M7541"],"date":["2024-05-12","2023-05-02","2023-05-04","2024-05-30","2023-06-20","2023-11-03","2023-07-12","2023-05-09","2023-05-17","2023-05-17","2023-06-19","2023-06-19","2023-06-19","2024-06-04","2024-06-04","2024-06-04","2024-06-04","2024-06-04","2023-07-12","2023-11-29","2023-11-29","2023-12-12","2023-10-04","2024-03-06","2023-10-30","2023-10-11","2023-10-11","2023-10-11","2023-11-29","2023-08-23","2023-08-23","2024-06-03","2024-06-03","2024-06-03","2024-06-03","2024-06-03","2023-08-23","2023-11-16","2023-11-16","2023-11-21","2023-11-29","2023-11-29","2024-03-06","2024-02-29","2024-02-26","2024-02-26","2023-12-28","2024-03-22","2024-03-22","2024-06-12","2024-06-12","2024-07-12","2024-07-12","2024-07-11","2024-07-11"],"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","10 MG","","Select","Select",""],["","","Doxycycline Monohydrate","100 MG","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Albuterol 0.083%","2.5 MG","","Select","Select",""],["","","Lisinopril","10 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","Rosuvastatin","40 MG","","Select","Select",""],["","","Famotidine","40 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Ezetimibe","10 MG","","Select","Select",""],["","","Azithromycin","500 MG","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Oxycodone Hcl\/Acetaminophen","5\/325 MG","","Select","Select",""],["","","Omeprazole","20 MG","","Select","Select",""],["","","Metoprolol Succ","25 MG","","Select","Select",""],["","","Nitroglycerin","0.4 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","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":""}]}]}