{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gregory A Black","gend":0,"currentgend":"","add":"19 WILLIAMS WAY APT 2","city":"ORRINGTON","state":"ME","zip":"04474","dob":"1951-03-25","age":"","mstatus":"","insh":"10000047536","cliId":"","pno":"2078251025","cno":"","email":"gblack6@roadrunner.com","ename":"","eno":"","pphy":"THERMOS, EMILY T","ppno":"2079891567","pcpadd":"Brewer Medical Center,735 Wilson St","pcpcity":"Brewer","pcpstate":"ME","pcpzip":"04412","pcpcounty":"","pcpid":"","pcpname":"BREWER MEDICAL CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"2079493811","add2":"","add3":"","madd1":"19 WILLIAMS WAY APT 2","madd2":"","madd3":"","mcity":"ORRINGTON","mstate":"ME","mzip":"04474","pcpfaxno":"2079892286","pcpnpi":"1396204707","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8MD8TJ3XF55","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M7989","C61","C7951","Z510","M160","M1611","Z5111","Z79899","Z7952","Z191","I10","Z23","E785","D649","M8580","Z0101","H40013","R7303","E1169","Z79818","M170","Z1211","Z860100","I082","I2720","L905","D225","L814","Z08","Z85828","L570","D485","D3701","Z0000","F1994","F19980","R4586","F418","B079","C44329","M85852","H6120","S8992XA","Z8546","M7732","F3289","R011","Z13820","I350","D122","D120","D123","L0390","C779","E119","I352","D1801","E663","E875","H18513","M899","R350","R591","K651","C419","R1909","M25551","R590","R6889","K4090"],"date":["2023-04-05","2026-02-06","2026-02-06","2023-04-04","2023-05-08","2025-09-15","2026-02-06","2026-02-26","2026-02-06","2026-02-06","2025-12-23","2025-10-09","2024-10-25","2024-10-25","2024-04-19","2025-03-13","2025-03-13","2024-04-19","2025-10-06","2024-06-27","2025-09-15","2025-06-13","2025-06-13","2025-04-18","2025-04-18","2025-05-28","2025-05-28","2025-12-03","2025-12-03","2025-12-03","2025-12-03","2025-05-28","2024-11-27","2025-08-14","2026-02-26","2026-02-26","2025-01-02","2025-04-25","2024-11-27","2025-02-21","2024-10-03","2025-08-25","2025-06-30","2025-03-26","2025-06-30","2025-02-25","2024-12-31","2024-10-03","2025-04-18","2025-06-13","2025-06-13","2025-06-13","2025-06-30","2023-03-20","2024-07-19","2025-12-22","2025-12-03","2025-10-06","2025-10-06","2023-03-07","2023-02-14","2023-02-14","2023-02-09","2023-02-24","2023-02-16","2023-02-24","2023-02-16","2023-02-16","2023-01-01","2023-01-18"],"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":[["","","PREDNISONE","5 MG","","Select","Select",""],["","","ATORVASTATIN","10 MG","","Select","Select",""],["","","AMLODIPINE","10 MG","","Select","Select",""],["","","METOPROLOL SUCC","100 MG","","Select","Select",""],["","","LISINOPRIL","40 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ABIRATERONE ACETATE","","","Select","Select",""],["","","BICALUTAMIDE","50 MG","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","ABIRATERONE","500 MG","","Select","Select",""],["","","SERTRALINE","50 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","50 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":""}]}]}