{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Howard D Pride","gend":0,"currentgend":"","add":"74 RUNNING HILL RD APT 101","city":"South Portland","state":"ME","zip":"04106","dob":"1942-03-13","age":"","mstatus":"","insh":"10000047979","cliId":"","pno":"2079396959","cno":"2079396959","email":"dpride@maine.rr.com","ename":"","eno":"","pphy":"KU RUTH, PHYLLIDIA M","ppno":"2077745816","pcpadd":"100 FODEN RD W,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41062319","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"74 RUNNING HILL RD APT 101","madd2":"","madd3":"","mcity":"South Portland","mstate":"ME","mzip":"04106","pcpfaxno":"2078741483","pcpnpi":"1497724108","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9GV5P05UC65","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C3431","C3490","J449","G620","I309","H40013","Z0101","L821","E2749","I4891","E2740","I2510","Z85118","Z8546","Z0001","I480","L723","Z23","I4710","N6001","N6341","R928","N6489","E279","I32","I959","R918","H903","I300","C3400","R6889","Z8679","I4820","Z7952","R200","R0982","R062","Z0000","R002","I499","Z7901","Z79899","N1831","R7301","H2513","H35373","I088","E7800","R7303","H2512","J069","I5020","H2511","R051","H5703","R413","R29818","C3491","R059"],"date":["2026-03-03","2024-11-04","2023-04-28","2023-04-28","2023-04-28","2023-06-02","2025-08-05","2023-07-20","2026-02-05","2023-10-06","2023-09-02","2025-12-11","2025-02-09","2026-03-03","2025-09-25","2025-06-26","2023-09-14","2025-09-25","2023-10-09","2023-10-25","2023-10-27","2023-10-27","2023-10-25","2026-03-03","2024-01-30","2023-11-02","2025-02-09","2024-10-16","2025-01-22","2025-06-26","2023-10-04","2024-07-09","2025-09-23","2025-08-06","2025-07-09","2025-04-14","2025-04-14","2024-09-19","2025-01-13","2025-01-14","2025-09-25","2025-01-13","2024-09-19","2024-09-19","2026-01-13","2026-01-13","2025-08-11","2025-09-25","2025-09-25","2026-02-04","2025-02-09","2025-08-11","2026-02-25","2025-04-16","2026-02-04","2025-07-15","2025-07-15","2025-11-03","2025-02-09"],"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":[["","","HYDROCORTISONE","5 MG","","Select","Select",""],["","","Metronidazole 0.75 % Cream Fougera","","","Select","Select",""],["","","Ketorolac 0.5 % Ophth Sol Micro Labs","","","Select","Select",""],["","","ATORVASTATIN","10 MG","","Select","Select",""],["","","PAXLOVID (MODERATE RENAL) PACK","","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","DEXAMETHASONE SODIUM PHOSPHATE","","","Select","Select",""],["","","Metronidazole 0.75 % Cream Viona Pharmaceu","","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","SOLU-CORTEF","","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","ABRYSVO W\/ DILUENT SYRINGE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","METRONIDAZOLE","0.0075","","Select","Select",""],["","","KETOROLAC","0.005","","Select","Select",""],["","","PREDNISOLONE ACE","0.01","","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":""}]}]}