{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donald S Decker","gend":0,"currentgend":"","add":"93 SAND RD","city":"CANAAN","state":"ME","zip":"04924","dob":"1949-09-22","age":"","mstatus":"","insh":"10000052608","cliId":"","pno":"2076297242","cno":"2073905509","email":"kfairchild1956@gmail.com","ename":"","eno":"","pphy":"THACKERAY, CARRIE E","ppno":"2079215900","pcpadd":"Pen Bay Family Medicine,15 Anchor Dr Ste 201","pcpcity":"Rockport","pcpstate":"ME","pcpzip":"04856","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"93 SAND RD","madd2":"","madd3":"","mcity":"CANAAN","mstate":"ME","mzip":"04924","pcpfaxno":"2075935358","pcpnpi":"1801903406","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3HH4VD9NR70","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z8673","E1142","E1122","N1830","F32A","Z95810","Z5181","M25532","R059","Z950","S50812A","Z7901","E1165","I129","Z0101","N401","R3915","R350","E119","N400","N390","Z0000","I77810","F418","E1140","I77811","R6889","I5042","R2242","M79672","M7989","M7732","M79605","M25572","M19072","G629","R55","I4729","I4710","I493","I088","Z0001","I639","H6122","I2510","I6320","R040","N6311","Z794","R928","N62","I429","I509"],"date":["2026-03-04","2025-07-30","2025-04-24","2024-10-22","2023-04-27","2025-12-17","2026-03-04","2023-07-07","2023-07-07","2023-07-07","2023-07-07","2026-03-04","2026-01-23","2024-10-22","2023-10-04","2023-10-02","2023-10-02","2023-10-02","2023-10-02","2023-10-04","2023-10-04","2025-10-28","2023-10-18","2023-10-18","2023-10-18","2023-11-03","2023-11-03","2025-03-20","2024-02-06","2024-02-28","2024-02-28","2024-02-26","2024-02-15","2024-02-26","2024-02-26","2024-02-28","2024-04-03","2024-04-03","2024-04-03","2024-04-03","2024-04-22","2024-10-22","2025-01-22","2025-01-22","2025-12-23","2025-12-09","2025-03-27","2023-02-27","2023-02-27","2023-03-07","2023-03-07","2023-01-17","2023-01-17"],"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":[["","","JANTOVEN","","","Select","Select",""],["","","Warfarin","5 MG","","Select","Select",""],["","","CEFPODOXIME","200 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","ATORVASTATIN","40 MG","","Select","Select",""],["","","Spironolactone","25 MG","","Select","Select",""],["","","ONETOUCH ULTRA","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","VENLAFAXINE","75 MG","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","Onetouch Ultra Blue","","","Select","Select",""],["","","LISINOPRIL","2.5 MG","","Select","Select",""],["","","METOPROLOL SUCC","25 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","400\/80 MG","","Select","Select",""],["","","GLIMEPIRIDE","2 MG","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","Insulin Degludec 200 Units\/Ml Inj (Pen) No","","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","TRESIBA FLEXTOUCH","","","Select","Select",""],["","","FLUAD QUAD","","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","INSULIN DEGLUDEC","200 UNITS\/ML","","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":""}]}]}