{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donald R Cook","gend":0,"currentgend":"","add":"92 NEW YORK AVE","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1950-11-24","age":"","mstatus":"","insh":"10000044030","cliId":"","pno":"2077764986","cno":"","email":"50cookdonald@gmail.com","ename":"","eno":"","pphy":"HORNE, JENNIFER L","ppno":"2079737979","pcpadd":"43 WHITING HILL RD,SUITE 300","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121005","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE GORHAM","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"92 NEW YORK AVE","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":"2079479579","pcpnpi":"1174903694","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2FE0PU9WT36","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I480","Z7901","Z87891","G4733","Z1211","D124","D125","K5730","G4730","I10","E6601","Z0101","H353131","Z136","Z0000","R7309","M25551","E119","R6889","D169","E785","E669","M549","R509","I700","J9811","L539","N485","R7989","A419","D122","K648","E1165","E66813","R202","M654","Z7985","G5703","L0390","L03115","Z0001","I6523","S81811A","W228XXA","J449","T2115XA","X088XXA","W408XXA"],"date":["2025-12-03","2023-06-27","2025-11-05","2026-03-11","2025-06-11","2023-05-31","2023-05-31","2025-06-11","2023-05-31","2024-06-20","2023-05-31","2023-07-27","2023-07-27","2023-08-14","2025-09-04","2023-07-27","2023-10-02","2025-12-11","2023-10-16","2023-10-02","2023-11-20","2023-11-20","2024-01-08","2024-06-10","2024-06-08","2024-06-10","2024-06-10","2024-07-02","2024-07-02","2024-07-12","2025-06-11","2025-06-11","2025-09-24","2025-07-02","2024-12-19","2025-12-04","2025-12-04","2024-09-05","2024-10-24","2025-07-31","2024-08-05","2025-12-03","2025-11-05","2025-11-05","2023-03-01","2023-01-25","2023-01-25","2023-01-25"],"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":[["","","Mupirocin 2 % Ointment Taro","","","Select","Select",""],["","","Levofloxacin","500 MG","","Select","Select",""],["","","DILTIAZEM","360 MG","","Select","Select",""],["","","PENICILLIN VK","500 MG","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","LISINOPRIL","20 MG","","Select","Select",""],["","","FLECAINIDE","50 MG","","Select","Select",""],["","","SPIKEVAX","","","Select","Select",""],["","","TIZANIDINE","4 MG","","Select","Select",""],["","","ROSUVASTATIN","20 MG","","Select","Select",""],["","","Chlorhexidine 0.12 % Oral Rinse Xttrium","","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","AMOXICILLIN","875 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","MUPIROCIN","0.02","","Select","Select",""],["","","CHLORHEXIDINE","0.0012","","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":""}]}]}