{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ronald L Gan","gend":0,"currentgend":"","add":"47 CUMBERLAND AVE","city":"PORTLAND","state":"ME","zip":"04101","dob":"1950-04-30","age":"","mstatus":"","insh":"10000040812","cliId":"","pno":"7739197078","cno":"","email":"munjoyhillhomes@gmail.com","ename":"","eno":"","pphy":"TOBIAS, TRISTAN D","ppno":"2077998596","pcpadd":"Martins Point Health Care,153 US Rte 1","pcpcity":"Scarborough","pcpstate":"ME","pcpzip":"04074","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"47 CUMBERLAND AVE","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04101","pcpfaxno":"2077991730","pcpnpi":"1003569203","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5JQ8D43EV37","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C61","Z8546","F419","K219","B182","K5732","I2510","E538","R911","R9721","Z0100","D381","Z87891","Z9079","F17200","R918","R846","Z23","H2511","H02403","Z13228","R252","R748","L308","L821","D225","D1801","H2512","H2513","H11122","D120","Z86010","D123","D492","H259","E782","Z113","Z114","N529","M25512","R079","S2241XA","Z08","R0489","J069","J45909","F418","S2241XD","R059","M542","H02822","R21","S40261A","W57XXXA","M19011","M19012","Z13220"],"date":["2026-01-09","2026-01-09","2025-09-26","2025-09-26","2025-09-26","2023-05-01","2026-01-14","2024-12-04","2023-06-06","2023-06-06","2025-07-29","2025-01-23","2025-01-15","2023-08-10","2023-08-10","2025-01-15","2023-08-10","2023-10-17","2024-03-04","2023-10-24","2024-12-04","2023-12-15","2024-01-30","2024-02-26","2024-02-26","2024-04-24","2024-02-26","2024-03-18","2024-04-08","2024-04-22","2024-05-14","2024-05-14","2024-05-14","2024-04-24","2024-03-18","2026-01-28","2025-10-09","2025-10-09","2026-01-09","2026-01-03","2026-01-03","2026-01-03","2025-08-08","2025-01-15","2025-10-12","2025-01-15","2025-01-15","2026-01-06","2025-01-23","2025-01-31","2025-10-31","2024-10-19","2024-10-19","2024-10-19","2025-07-23","2025-07-23","2024-12-04"],"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":[["","","ATORVASTATIN","20 MG","","Select","Select",""],["","","CYCLOBENZAPRINE","10 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","FLUZONE HIGH-DOSE","","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","MELOXICAM","15 MG","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","PENICILLIN VK","500 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","Ofloxacin 0.3 % Ophth Sol Armas","","","Select","Select",""],["","","Ketorolac 0.5 % Ophth Sol Apotex","","","Select","Select",""],["","","Ofloxacin 0.3 % Ophth Sol Rising","","","Select","Select",""],["","","Neo\/Polymyx\/Dex 3.5\/10","","","Select","Select",""],["","","NEO\/POLYMYX\/DEX","","","Select","Select",""],["","","KETOROLAC","0.005","","Select","Select",""],["","","PREDNISOLONE ACE","0.01","","Select","Select",""],["","","OFLOXACIN","0.003","","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":""}]}]}