{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"George R Lebeuf","gend":0,"currentgend":"","add":"184 WESTVIEW DRIVE","city":"SANFORD","state":"ME","zip":"04073","dob":"1950-09-16","age":"","mstatus":"","insh":"10000042880","cliId":"","pno":"2073240278","cno":"","email":"georgelebeuf@breezeline.net","ename":"","eno":"","pphy":"GIBSON, JENNER","ppno":"","pcpadd":"MaineHealth Primary Care Family Medicine,25A June St Ste 111","pcpcity":"Sanford","pcpstate":"ME","pcpzip":"04073","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"2075022987","add2":"","add3":"","madd1":"184 WESTVIEW DRIVE","madd2":"","madd3":"","mcity":"SANFORD","mstate":"ME","mzip":"04073","pcpfaxno":"","pcpnpi":"1902286131","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9XY0A61DC10","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z45018","I255","I2510","Z951","I5042","L89610","E08621","I739","L97511","E11621","Z95828","L7634","Z952","I081","I088","I77810","I5030","I110","I509","E119","I70234","I7092","E1151","L97412","T82898A","Z950","Z125","I10","D62","L03115","L089","M7731","E1140","L97909","L0390","I70239","E785","R4182","I70261","A000","Z01818","L97529","G8918","I96","R310","E782","E1152","S81801A","Z98890","Z4801","L97416","T8189XA","S91301A","L03031","M19071","M7989","S81801D","R0609","D509","D696","Z8546","J309","H1013","E1142","R0602","Z0000","I5022","Z1331","Z1389","J984","E8352","E113213","D649","I480","R918","J9601","J159","R079","R9720","I5020","E8342","E875","I5043","R059","R0689","J90","I252","I4891","Z7901","R0989","J189","R051","R040","Z48817"],"date":["2023-04-14","2026-01-02","2024-12-11","2023-04-13","2023-04-13","2023-05-16","2023-05-16","2024-05-16","2023-05-16","2024-09-17","2023-07-31","2023-05-22","2023-06-29","2023-06-29","2023-06-29","2023-06-29","2023-06-27","2023-06-30","2023-11-10","2024-03-18","2023-06-30","2023-06-30","2024-03-11","2023-06-30","2023-07-31","2024-04-02","2023-10-25","2025-04-25","2023-10-25","2024-03-09","2024-04-05","2024-03-09","2024-03-09","2024-03-11","2024-03-11","2024-03-18","2024-03-18","2024-03-18","2024-04-01","2024-04-08","2024-04-02","2024-04-02","2024-04-03","2024-04-03","2024-04-03","2025-09-22","2024-04-02","2024-07-16","2024-05-03","2024-05-08","2024-08-20","2024-08-06","2024-07-16","2024-05-31","2024-06-03","2024-06-03","2024-07-12","2025-11-04","2025-12-15","2025-11-04","2025-11-04","2025-07-18","2025-07-18","2025-09-16","2025-11-04","2025-12-15","2025-05-02","2025-12-15","2025-12-15","2025-11-04","2025-05-20","2024-12-19","2025-10-31","2025-10-23","2025-04-16","2025-04-16","2025-04-16","2025-04-21","2026-02-16","2025-11-19","2025-09-16","2025-09-16","2025-04-18","2025-02-17","2025-04-07","2025-11-07","2025-05-02","2025-05-02","2025-05-02","2025-02-17","2025-04-16","2023-03-15","2023-02-24","2023-01-26"],"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",""],["","","Triamcinolone Acet 0.1 % Cream Taro","","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","FLUTICASONE PROP","50 MCG","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","LISINOPRIL","5 MG","","Select","Select",""],["","","ATORVASTATIN","40 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","GLIPIZIDE","10 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Fougera","","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","METOPROLOL SUCC","25 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Encube","","","Select","Select",""],["","","GABAPENTIN","100 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","MONTELUKAST","10 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Ascend Labs","","","Select","Select",""],["","","SPIRONOLACTONE","25 MG","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","LOKELMA","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.001","","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":""}]}]}