{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Walter H Frati","gend":0,"currentgend":"","add":"41 LONGRAIL PARK APT B","city":"BANGOR","state":"ME","zip":"04401","dob":"1947-11-01","age":"","mstatus":"","insh":"10000038869","cliId":"","pno":"2079496322","cno":"2079496322","email":"huntster47@live.com","ename":"","eno":"","pphy":"COLLINS, AMANDA S","ppno":"2079412373","pcpadd":"EMMC Husson Family Medicine,302 Husson Ave Ste 2","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HUSSON FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"41 LONGRAIL PARK APT B","madd2":"","madd3":"","mcity":"BANGOR","mstate":"ME","mzip":"04401","pcpfaxno":"2079418803","pcpnpi":"1881960458","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6AU3Y46TF98","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1712","Z7982","Z471","Z96652","I10","Z87891","E782","N1830","N433","Z0101","H524","Z961","H25811","R399","R39198","R351","N529","Z87438","Z8042","H348320","H43812","H2511","M5450","Z86010","K5730","D125","K642","Z1211","K219","Z0000","M5031","M47812","M5137","M47817","M5030","M5136","I129","H6990","H5203","H52223"],"date":["2023-04-03","2023-04-03","2023-10-16","2023-10-16","2023-10-19","2023-07-03","2024-04-24","2024-04-24","2023-08-11","2024-06-06","2024-06-06","2024-03-19","2023-07-25","2023-07-28","2023-08-11","2023-11-21","2023-11-16","2023-07-28","2023-07-28","2024-03-19","2024-03-19","2024-03-19","2023-09-11","2023-10-03","2023-10-03","2023-10-03","2023-10-03","2023-10-03","2023-10-18","2023-10-19","2024-02-05","2024-02-05","2024-02-05","2024-02-05","2024-02-05","2024-02-05","2024-04-24","2024-06-04","2024-06-06","2024-06-06"],"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":[["","","Amoxicillin","500 MG","","Select","Select",""],["","","Trazodone","50 MG","","Select","Select",""],["","","Atorvastatin","10 MG","","Select","Select",""],["","","Mnexspike","","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Tamsulosin","0.4 MG","","Select","Select",""],["","","Peg 3350\/Electrolytes","420 GM","","Select","Select",""],["","","Omeprazole","20 MG","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Fluocinonide 0.05 % Top Sol Sun Pharma","","","Select","Select",""],["","","Amlodipine","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":""}]}]}