{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Steven E Jordan","gend":0,"currentgend":"","add":"410 MARSTON HILL RD","city":"MINOT","state":"ME","zip":"04258","dob":"1954-04-24","age":"","mstatus":"","insh":"10000031597","cliId":"","pno":"2077842242","cno":"2075765985","email":"Dijordan2@aol.com","ename":"","eno":"","pphy":"DUQUETTE, ADAM","ppno":"2077847388","pcpadd":"190 STETSON RD,","pcpcity":"AUBURN","pcpstate":"ME","pcpzip":"42107813","pcpcounty":"","pcpid":"","pcpname":"FAMILY HEALTH CARE ASSOCIATES","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"410 MARSTON HILL RD","madd2":"","madd3":"","mcity":"MINOT","mstate":"ME","mzip":"04258","pcpfaxno":"2077952043","pcpnpi":"1679884522","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8E91JN5GG33","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25551","M25552","Z4889","R399","I69954","Z7901","I82409","U071","I6350","N3941","Z1211","K5730","Z86010","Z1212","K621","H53462","G8190","R6889","G40219","I6930","F419","F32A","F331","N400","F329","Z96641","Z471","R569","Z0000","L820","L538","L298","I69354","G4730","R269","E669","M25372","M10072","M79672","Z008","S2231XA","F3341","M7989","Z043","R0600","R509","H903","Z09","W19XXXA","R0602","D126","R300","R208","D1721","L814","D225","L821","I10","Z8673","M19071","F4321","J189","J9811","C61","M79671","L304","L738","I69359","G4733","M1711","S3991XA","S3993XA","S8012XA","M722","R197","R059","M25561","S299XXA","S7001XA","W010XXA","N401","R3915","Z1152","M5416","R2242","S8010XA","S199XXA","S0990XA","I639","J9601","T148XXA","A419","L600","R32","R109","N390","N50811","N5082","N433","N503","L089"],"date":["2026-03-02","2026-03-02","2026-03-02","2024-09-06","2025-04-10","2026-01-21","2026-01-21","2023-05-08","2024-12-12","2025-09-10","2023-05-26","2023-05-26","2023-05-26","2023-05-26","2023-05-26","2026-01-20","2023-08-07","2023-09-04","2025-11-14","2023-10-30","2023-10-30","2023-10-30","2025-01-20","2025-05-27","2024-01-04","2023-12-01","2023-12-01","2024-03-29","2024-04-02","2024-03-27","2024-03-27","2024-03-27","2025-11-14","2024-04-18","2025-11-14","2025-10-10","2025-12-11","2025-12-31","2025-12-31","2025-04-08","2025-02-05","2025-11-14","2025-12-18","2025-01-31","2024-10-30","2024-09-02","2025-05-01","2025-02-05","2025-02-05","2025-02-05","2025-04-01","2025-10-29","2023-03-22","2023-03-22","2025-03-27","2025-03-27","2023-03-22","2025-10-10","2025-01-31","2024-11-07","2025-09-18","2024-09-13","2025-02-05","2025-09-10","2025-11-13","2025-03-27","2025-03-27","2023-03-28","2023-03-28","2025-09-17","2025-06-25","2025-06-25","2025-06-30","2024-11-18","2024-09-18","2024-09-02","2025-09-17","2025-06-25","2025-06-25","2025-06-25","2025-06-13","2025-11-14","2024-08-29","2025-07-16","2025-06-30","2025-07-03","2025-06-25","2025-06-25","2025-11-14","2024-09-06","2025-06-25","2024-09-02","2025-11-13","2023-03-10","2023-02-01","2023-01-21","2023-01-21","2023-01-21","2023-01-21","2023-01-21","2023-01-27"],"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",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","Ketoconazole 2 % Cream Teva","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","METHYLPHENIDATE","10 MG","","Select","Select",""],["","","METOPROLOL SUCC","100 MG","","Select","Select",""],["","","GEMTESA","","","Select","Select",""],["","","LEVOFLOXACIN","250 MG","","Select","Select",""],["","","BUPROPION HCL","150 MG","","Select","Select",""],["","","OXYBUTYNIN","10 MG","","Select","Select",""],["","","BACLOFEN","20 MG","","Select","Select",""],["","","AMLODIPINE","5 MG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","CLONIDINE","0.3 MG\/24HR","","Select","Select",""],["","","NITROFURANTOIN","100 MG","","Select","Select",""],["","","Ketoconazole 2 % Cream Encube","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","CITALOPRAM","40 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","HYDRALAZINE","10 MG","","Select","Select",""],["","","Enoxaparin Pf","150 MG","","Select","Select",""],["","","Alclometasone Diprop 0.05 % Cream Taro","","","Select","Select",""],["","","WARFARIN","4 MG","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","SPIRONOLACTONE","50 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","OXCARBAZEPINE","600 MG","","Select","Select",""],["","","Peg 3350\/Electrolytes","420 GM","","Select","Select",""],["","","PAXLOVID","300\/100 MG","","Select","Select",""],["","","ROSUVASTATIN","20 MG","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","NITROFURANTOIN MACRO\/MONO","100 MG","","Select","Select",""],["","","METHYLPREDNISOLONE","4 MG","","Select","Select",""],["","","CIPROFLOXACIN","250 MG","","Select","Select",""],["","","ALCLOMETASONE DIPROPIONATE","","","Select","Select",""],["","","ALCLOMETASONE DIPROP","0.0005","","Select","Select",""],["","","ENOXAPARIN SODIUM","","","Select","Select",""],["","","FLUAD QUAD","","","Select","Select",""],["","","PEG","3350\/ELECTROLYTES 420","","Select","Select",""],["","","KETOCONAZOLE","0.02","","Select","Select",""],["","","VALACYCLOVIR","1 GM","","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":""}]}]}