{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gary D Snider","gend":0,"currentgend":"","add":"910 CHADBOURNE RIDGE RD","city":"NORTH WATERBORO","state":"ME","zip":"04061","dob":"1947-05-10","age":"","mstatus":"","insh":"10000051541","cliId":"","pno":"2078859382","cno":"2072470247","email":"paulinewarg@roadrunner.com","ename":"","eno":"","pphy":"TOBIAS, TRISTAN D","ppno":"2077998596","pcpadd":"Martins Point Health Care,153 US Rte 1","pcpcity":"Scarborough","pcpstate":"ME","pcpzip":"04074","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"910 CHADBOURNE RIDGE RD","madd2":"","madd3":"","mcity":"NORTH WATERBORO","mstate":"ME","mzip":"04061","pcpfaxno":"2077991730","pcpnpi":"1003569203","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4F46NW1FA43","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":["S199XXA","S0990XA","M542","Z85828","Z87891","R0602","N3001","R9431","F32A","M069","E876","W19XXXS","Y92009","K5900","M549","S0181XA","S80912A","Z515","R296","G3184","N3090","M6281","E039","R410","R339","R4189","Z66","S0101XA","S129XXA","M25511","M25562","R1310","R110","B379","N3941","K5901","I951","G901","K5909","D649","R1312","R6330","R0989","K224","R7989","E785","I959","N401","D044","D045","D492","D225","L821","L570","R309","R5383","Z0000","I77810","E8342","I4510","R42","R531","U071","I340","R509","R350","R300","S50811A","Z741","R2681","M1990","R55","D84821","F05","I454","J1189","M0550","W1789XA","S060X1A","S065XAA","W19XXXA","I629","S065X0A","S066X0A","S3993XA","S299XXA","R918","K219","K449","K2289","F418","R627","S62337A","S6992XA","K2950","K2210","A419","E43","J189","J9601","F03918","E440","Z01818","C4442","M25551","Z043","W010XXA","L602","R262","G609","M205X1","S0011XA","Y92511","Y92129","D7589","I499","M160","Z96641","Z471","R000","R269","M1611","D0422","R4182","Z743","L578","G959","Z7189","S0102XA","F0390","Z4802","S0102XD","I4710","I4720","R008","J439","J90","R069","D729","G9341","R739","E673","L218","S62307A","M1612","W06XXXA","Z23","M25569","Z8639","I081"],"date":["2025-09-25","2025-09-25","2025-05-06","2025-08-04","2025-05-28","2025-10-13","2023-04-11","2025-10-03","2023-09-21","2026-02-16","2023-04-10","2023-04-10","2024-04-15","2023-04-09","2023-04-07","2025-01-29","2023-04-04","2025-09-29","2025-10-08","2023-09-18","2023-05-09","2023-09-18","2025-05-28","2025-09-26","2025-04-28","2023-04-28","2024-06-20","2023-04-04","2023-04-04","2024-12-18","2023-04-04","2025-10-15","2023-04-18","2023-04-20","2024-01-02","2023-04-24","2025-10-08","2023-06-11","2023-05-09","2024-11-05","2023-04-24","2023-04-24","2023-04-24","2023-04-24","2023-05-19","2025-05-28","2023-05-25","2023-05-25","2026-01-20","2024-09-30","2025-08-04","2025-08-04","2024-08-12","2025-08-04","2023-06-15","2023-06-15","2023-07-06","2023-07-06","2023-09-15","2023-09-12","2023-09-12","2025-10-03","2023-09-25","2023-09-12","2025-10-13","2025-03-21","2023-09-11","2023-09-11","2023-09-21","2023-09-21","2023-09-21","2023-09-17","2023-11-18","2023-09-11","2023-09-18","2023-09-11","2023-11-18","2025-05-06","2024-04-15","2024-04-15","2026-01-13","2024-04-15","2024-04-14","2024-04-14","2024-04-15","2024-04-15","2024-06-15","2024-06-17","2024-06-20","2024-06-17","2024-06-20","2025-09-29","2024-07-01","2024-07-01","2024-06-20","2024-06-20","2026-02-11","2024-06-20","2025-10-13","2025-10-13","2025-10-08","2025-10-08","2025-03-21","2026-01-20","2025-03-20","2026-01-28","2026-01-28","2026-01-14","2026-01-14","2026-01-14","2026-01-14","2025-01-29","2025-01-29","2026-01-13","2024-11-20","2025-08-25","2024-11-15","2025-10-16","2025-10-16","2024-09-16","2024-12-02","2025-05-30","2024-12-09","2025-10-22","2025-10-22","2025-12-09","2024-12-02","2025-09-29","2025-07-30","2025-09-24","2025-08-13","2025-08-13","2024-09-30","2024-09-30","2024-09-30","2025-10-16","2025-10-16","2025-10-13","2024-11-05","2025-10-13","2024-11-05","2024-08-20","2025-12-09","2024-06-05","2025-05-28","2025-12-06","2024-08-13","2024-08-02","2025-01-06","2023-03-03"],"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":[["","","ONDANSETRON","4 MG","","Select","Select",""],["","","Mirtazapine","7.5 MG","","Select","Select",""],["","","RISPERIDONE","0.5 MG","","Select","Select",""],["","","SOLIFENACIN","10 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","Albuterol\/Ipratropium","3\/0.5 MG","","Select","Select",""],["","","RAMELTEON","8 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","Amoxicillin\/Clav","600\/42.9 MG","","Select","Select",""],["","","MIDODRINE","2.5 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","OMEPRAZOLE","40 MG","","Select","Select",""],["","","TAMSULOSIN","0.4 MG","","Select","Select",""],["","","PAXLOVID","300\/100 MG","","Select","Select",""],["","","POTASSIUM CL","20 MEQ","","Select","Select",""],["","","BUPROPION HCL","100 MG","","Select","Select",""],["","","CLINDAMYCIN","300 MG","","Select","Select",""],["","","FLUCONAZOLE","200 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","CIPROFLOXACIN","250 MG","","Select","Select",""],["","","CELECOXIB","100 MG","","Select","Select",""],["","","Chlorhexidine 0.12 % Oral Rinse Xttrium","","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","TRAZODONE","50 MG","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","HYDROXYCHLOROQUINE","200 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":""}]}]}