{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Richard L France","gend":0,"currentgend":"","add":"92 PINEWOODS RD","city":"LISBON","state":"ME","zip":"04250","dob":"1966-05-09","age":"","mstatus":"","insh":"10000039347","cliId":"","pno":"2077407255","cno":"","email":"declined@08292025.com","ename":"","eno":"","pphy":"TAYLOR, ISABELLA","ppno":"2077952800","pcpadd":"CMMC Family Medicine Residency Program,76 High St Ste 200","pcpcity":"Lewiston","pcpstate":"ME","pcpzip":"04240","pcpcounty":"","pcpid":"","pcpname":"TOPSHAM FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"92 PINEWOODS RD","madd2":"","madd3":"","mcity":"LISBON","mstate":"ME","mzip":"04250","pcpfaxno":"","pcpnpi":"1235696600","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7YX1WC3QV33","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","M25511","C61","R9720","N1330","Z5111","R399","N3289","N390","N1339","R600","C679","C7951","C7971","R1032","R300","M7989","Z439","R221","R590","C678","M898X5","M898X6","M899","E785","Z79633","Z79818","N139","N281","R1909","N135","Z13228","D494","G5720","Z800","Z803","Z48816","Z466","R2242"],"date":["2025-03-27","2025-10-27","2026-02-18","2025-08-15","2026-01-22","2026-02-17","2025-10-22","2026-01-06","2026-02-04","2026-02-04","2025-08-09","2025-10-28","2026-01-05","2026-01-26","2025-08-09","2025-08-09","2025-08-09","2025-09-22","2025-09-19","2025-08-15","2025-08-19","2025-11-07","2026-01-06","2025-11-07","2025-03-27","2026-01-26","2026-01-26","2025-12-05","2026-01-22","2025-07-10","2025-09-03","2025-03-12","2026-02-04","2025-10-13","2025-10-13","2025-10-13","2025-08-20","2025-08-20","2025-08-09"],"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":[["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","OXYBUTYNIN","5 MG","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","PROCHLORPERAZINE","10 MG","","Select","Select",""],["","","Diazepam","5 MG","","Select","Select",""],["","","ONDANSETRON","8 MG","","Select","Select",""],["","","ERLEADA","","","Select","Select",""],["","","FIRMAGON","","","Select","Select",""],["","","BICALUTAMIDE","50 MG","","Select","Select",""],["","","CYCLOBENZAPRINE","5 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","NUBEQA","","","Select","Select",""],["","","TAMSULOSIN","0.4 MG","","Select","Select",""],["","","CIPROFLOXACIN","500 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":""}]}]}