{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Walter N Riseman","gend":0,"currentgend":"","add":"5 SMITH ST","city":"Harrison","state":"ME","zip":"04040","dob":"1947-12-02","age":"","mstatus":"","insh":"10000046315","cliId":"","pno":"2075832804","cno":"","email":"wriseman@gmail.com","ename":"","eno":"","pphy":"LAPHAM, DAVID A","ppno":"2077446444","pcpadd":"Western Maine Primary Care,8 Pikes Hill Rd","pcpcity":"Norway","pcpstate":"ME","pcpzip":"04268","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY AND INTERNAL MEDIC","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"2078907866","add2":"","add3":"","madd1":"PO BOX 543","madd2":"","madd3":"","mcity":"Harrison","mstate":"ME","mzip":"04040","pcpfaxno":"2077436306","pcpnpi":"1548765753","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4PT5W88GQ55","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L738","R198","H01001","I7120","I351","I358","I5189","S90464A","L03031","L0390","R5383","Z96641","M25551","M47816","M169","R9720","K4090","N401","N3941","R350","M1612","M7061","M48062","R258","Z9189","R519","M549","M419","M5136","N281","M5126","M5450","M5416","S39012A","Z13220","H9191","J3489","Z0000","Z23","R109","R142","H903","R040","K635","K5730","N400","I6782","G8929","F32A","R4189","Z1211","Z538","K648","F39","K5641","I10","E669","G4733","H1131","K22719","K219","R4182"],"date":["2023-04-03","2023-08-29","2023-05-07","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-06-04","2023-06-05","2023-06-08","2023-11-08","2023-08-24","2023-12-26","2024-04-19","2023-06-20","2023-06-29","2023-11-27","2024-01-17","2023-07-05","2023-07-05","2023-07-31","2023-10-03","2024-06-25","2023-12-24","2023-12-24","2023-12-12","2023-08-25","2023-08-24","2024-04-19","2023-11-27","2023-08-26","2023-08-24","2023-08-25","2023-08-25","2023-09-20","2023-09-28","2023-11-15","2023-09-20","2023-11-08","2023-11-27","2023-11-10","2023-11-15","2023-11-15","2023-11-29","2024-05-20","2023-11-27","2023-12-12","2023-12-12","2023-12-27","2024-01-05","2024-05-20","2024-01-31","2024-01-31","2024-02-02","2024-01-31","2024-01-31","2024-01-31","2024-06-10","2024-04-18","2024-05-20","2024-05-20","2024-05-20"],"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":[["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Gavilyte-G","","","Select","Select",""],["","","Mupirocin 2 % Ointment Padagis","","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Alprazolam","0.5 MG","","Select","Select",""],["","","Donepezil","5 MG","","Select","Select",""],["","","Ezetimibe","10 MG","","Select","Select",""],["","","Tizanidine","2 MG","","Select","Select",""],["","","Atorvastatin","80 MG","","Select","Select",""],["","","Peg 3350\/Electrolytes","236 GM","","Select","Select",""],["","","Fluoxetine","20 MG","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Duloxetine","60 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","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":""}]}]}