{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Timothy R Spence","gend":0,"currentgend":"","add":"9 CANNON HILL RD","city":"LIMERICK","state":"ME","zip":"04048","dob":"1949-07-28","age":"","mstatus":"","insh":"10000041184","cliId":"","pno":"2074327306","cno":"","email":"declined@090722.com","ename":"","eno":"","pphy":"GALBRAITH, KATHRYN L","ppno":"","pcpadd":"44 ELM ST,","pcpcity":"LIMERICK","pcpstate":"ME","pcpzip":"40483924","pcpcounty":"","pcpid":"","pcpname":"GALBRAITH FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"9 CANNON HILL RD","madd2":"","madd3":"","mcity":"LIMERICK","mstate":"ME","mzip":"04048","pcpfaxno":"2077939587","pcpnpi":"1740240290","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8RK1QQ9NC90","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R4182","I639","I2510","I517","E785","I739","F17200","I6523","I6502","I6389","I69398","I69320","Z7902","I63312","G9349","R7401","Z7409","Z7389","R0602","I63512","A000","R0782","I6990","M353","F17210","I6522","R197","I69928","R531","R4701","I63232","R451","Z7982","F329","F320","B353","Z23","R1032","K5900","R9720","I70201","R609","R7301","L97519","I10","J449","M2550","M7910","L97811","Z720","N401","I69920","Z87891","R634"],"date":["2023-04-08","2023-04-06","2023-05-25","2023-04-03","2025-12-01","2025-04-28","2023-11-01","2025-04-28","2023-04-02","2023-04-05","2023-06-27","2023-06-04","2023-04-08","2023-04-02","2023-04-02","2023-04-02","2023-04-13","2023-04-13","2023-04-02","2023-04-28","2023-05-05","2023-04-25","2025-12-01","2025-08-13","2023-11-01","2023-05-08","2024-02-12","2023-05-25","2023-05-26","2023-04-20","2023-06-05","2023-06-27","2023-06-27","2023-07-17","2023-08-07","2023-08-07","2023-11-13","2023-11-13","2023-11-13","2025-11-05","2025-06-05","2023-03-29","2025-12-01","2025-02-19","2025-02-19","2025-12-01","2023-03-29","2023-03-29","2025-03-12","2025-03-12","2025-06-17","2025-05-01","2023-03-16","2023-01-16"],"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":[["","","ESCITALOPRAM","10 MG","","Select","Select",""],["","","Mometasone 0.1 % Ointment Padagis","","","Select","Select",""],["","","Ketoconazole 2 % Cream Encube","","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","Diclofenac Sod 1 % Gel Encube","","","Select","Select",""],["","","ATORVASTATIN","40 MG","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","MOMETASONE","0.001","","Select","Select",""],["","","KETOCONAZOLE","0.02","","Select","Select",""],["","","DICLOFENAC SOD","0.01","","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":""}]}]}