{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Russell P Ross","gend":0,"currentgend":"","add":"25 PORCH ST","city":"Portland","state":"ME","zip":"04103","dob":"1949-06-14","age":"","mstatus":"","insh":"10000043784","cliId":"","pno":"","cno":"2072522057","email":"claire.m.ross@gmail.com","ename":"","eno":"","pphy":"POULIN, SAMUEL J","ppno":"2078282402","pcpadd":"Martins Point Health Care,331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"25 PORCH ST","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04103","pcpfaxno":"2078282433","pcpnpi":"1841827003","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1U14PW7QW77","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":["E785","I340","I517","Z952","Z7901","Z23","E119","M1711","M1712","M19071","I480","I779","I4729","M170","Z96643","E669","Z471","Z96641","M7061","M542","M61551","T8484XA","H35373","Z130","Z125","Z13228","E781","Z136","I152","R6889","Z96653","D492","L570","L578","D225","L814","L821","M25569","C44712","D0439","I3481","Z01818","A000","M21062","G8918","I10","K219","Z96642","M25462","Z96652","M25562","M25662","M7062"],"date":["2023-04-06","2023-04-06","2023-04-06","2023-07-05","2024-06-19","2023-10-04","2024-05-01","2024-06-11","2024-05-14","2023-05-25","2023-07-05","2023-07-05","2023-07-05","2024-02-21","2024-07-02","2024-05-14","2024-06-11","2024-02-15","2024-07-02","2023-11-02","2023-10-26","2023-10-26","2023-11-15","2023-12-12","2023-12-12","2023-12-12","2023-12-12","2023-12-12","2024-01-31","2023-01-01","2024-02-21","2024-02-23","2024-02-23","2024-02-23","2024-02-23","2024-02-23","2024-02-23","2024-02-21","2024-02-23","2024-02-23","2024-04-10","2024-04-22","2024-05-16","2024-05-14","2024-05-14","2024-05-14","2024-05-14","2024-05-28","2024-07-10","2024-07-10","2024-07-10","2024-07-10","2024-07-02"],"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":[["","","Hydromorphone","2 MG","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Warfarin","4 MG","","Select","Select",""],["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Amitriptyline","50 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","Pregabalin","75 MG","","Select","Select",""],["","","Losartan","25 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Prednisone","2.5 MG","","Select","Select",""],["","","Tramadol","50 MG","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Ozempic","","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Glipizide","5 MG","","Select","Select",""],["","","Rosuvastatin","20 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":""}]}]}