{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Allen R Goodwin","gend":0,"currentgend":"","add":"27 GOODWIN LANE","city":"Lyman","state":"ME","zip":"04002","dob":"1949-02-09","age":"","mstatus":"","insh":"10000051798","cliId":"","pno":"2072069871","cno":"","email":"Argoodwin781@gmail.com","ename":"","eno":"","pphy":"FARINO, BENEDICT J","ppno":"2078833491","pcpadd":"190 RIVERSIDE ST,SUITE 6B","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41031073","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"27 GOODWIN LANE","madd2":"","madd3":"","mcity":"LYMAN","mstate":"ME","mzip":"04002","pcpfaxno":"2078855587","pcpnpi":"1104912864","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5HW0TW5QK34","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N1831","E1122","N1830","Z794","R7989","E113293","H40053","H2513","Z0000","E113292","L570","L871","Z85828","E881","R233","I129","I2510","R0600","R002","M79605","L299","R1900","I10","R801","B349","Z951","Z1152","M25561","M25562","M170","G8929","I25119","L821","D492"],"date":["2024-05-16","2023-08-07","2023-06-06","2023-06-06","2023-06-06","2023-06-14","2023-06-14","2023-06-14","2023-06-26","2024-05-16","2024-06-14","2023-06-09","2023-06-09","2023-06-09","2023-06-09","2023-08-07","2023-08-07","2023-08-21","2023-09-18","2023-10-11","2023-09-18","2023-09-18","2024-03-12","2024-03-11","2024-02-28","2024-02-28","2024-02-28","2024-06-03","2024-06-03","2024-06-03","2024-06-03","2024-06-04","2024-06-14","2024-06-14"],"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":[["","","Naltrexone","50 MG","","Select","Select",""],["","","Lisinopril","10 MG","","Select","Select",""],["","","Insulin Syringe","","","Select","Select",""],["","","Simvastatin","10 MG","","Select","Select",""],["","","Clobetasol 0.05 % Cream Taro","","","Select","Select",""],["","","Naltrexone Hcl","","","Select","Select",""],["","","Mounjaro","","","Select","Select",""],["","","Capvaxive","","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Atenolol","25 MG","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Nitroglycerin","0.4 MG","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Metformin","500 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":""}]}]}