{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gilbert H Page","gend":0,"currentgend":"","add":"4 L ST","city":"BANGOR","state":"ME","zip":"04401","dob":"1937-10-30","age":"","mstatus":"","insh":"10000038512","cliId":"","pno":"2073853046","cno":"2073853046","email":"gilpage34@gmail.com","ename":"","eno":"","pphy":"LANGLEY, AMY A","ppno":"","pcpadd":"PO BOX 1599,","pcpcity":"BANGOR","pcpstate":"ME","pcpzip":"44021599","pcpcounty":"","pcpid":"","pcpname":"PENOBSCOT COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"4 L ST","madd2":"","madd3":"","mcity":"BANGOR","mstate":"ME","mzip":"04401","pcpfaxno":"2079470435","pcpnpi":"1083906622","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3GN8KP7XA29","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4891","I4821","I2510","I480","I361","R079","I10","I5030","E119","H26492","S82832A","M25572","M79672","S82432A","X58XXXA","S99922A","X501XXA","S82432D","X58XXXD","I081","I77810","I252","S82832D","I5032","J449","I4820","N1832","Z23","I110","I498","E1122","I4819","Z0000","I2720","E1142","Z0101","H5203","H524","H52223","E782","E1121","E1165","H43811","H43812"],"date":["2023-12-06","2023-10-04","2025-12-18","2025-06-11","2023-09-27","2023-10-04","2025-12-18","2023-12-07","2025-03-31","2023-10-23","2023-12-11","2023-11-13","2023-11-13","2023-11-15","2023-11-15","2023-11-13","2023-11-20","2023-12-06","2023-12-20","2025-04-24","2025-04-24","2023-12-11","2024-02-20","2025-12-18","2024-01-29","2025-03-31","2025-09-22","2024-12-06","2025-12-18","2024-11-01","2025-09-22","2025-12-18","2025-09-03","2025-04-24","2025-06-30","2024-10-24","2024-10-24","2024-10-24","2024-10-24","2025-06-11","2025-12-31","2025-09-29","2023-02-13","2023-02-13"],"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":[["","","Torsemide","20 MG","","Select","Select",""],["","","Pravastatin","40 MG","","Select","Select",""],["","","Chlorpromazine","25 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Metoprolol Succ","100 MG","","Select","Select",""],["","","Bd Ultra-Fine Micro","","","Select","Select",""],["","","Eliquis","","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Chlorthalidone","25 MG","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","Nitroglycerin","0.4 MG","","Select","Select",""],["","","Metoprolol Succinate","","","Select","Select",""],["","","Comirnaty 2023-2024","","","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":""}]}]}