{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Alan F Mast","gend":0,"currentgend":"","add":"30 GOVERNORS WAY UNIT 612","city":"Topsham","state":"ME","zip":"04086","dob":"1932-11-26","age":"","mstatus":"","insh":"10000052705","cliId":"","pno":"2077983938","cno":"2073198231","email":"alanmast21@gmail.com","ename":"","eno":"","pphy":"DECK, MARCUS M","ppno":"2077984400","pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"THE HIGHLANDS 30 GOVERNORS WAY 612","madd2":"","madd3":"","mcity":"Topsham","mstate":"ME","mzip":"04086","pcpfaxno":"2077984018","pcpnpi":"1891717872","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3YP6AY3UW77","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":["H903","M25561","M1711","K219","Z0100","D649","E785","B351","M79674","M79675","M25461","L570","Z85828","L308","D229","S83281A","S83241A","M23300","M23303","M84351A","M25551","L600","M1611","Z23","M79651","D044","C44329","L821","J069","D492","D729","R059","R509","J189","R1012","R109","K4090","N281","K5790","K8020","Z8673"],"date":["2023-04-26","2023-08-03","2023-11-07","2023-05-10","2024-06-12","2023-06-16","2024-06-19","2024-06-26","2024-06-26","2024-06-26","2023-08-04","2024-02-15","2024-01-17","2023-07-19","2024-01-17","2023-08-03","2023-08-03","2023-10-23","2023-10-23","2023-10-23","2023-09-27","2023-09-22","2023-11-29","2023-10-18","2023-12-19","2024-02-15","2024-02-15","2024-02-15","2024-02-03","2024-01-17","2024-06-19","2024-06-19","2024-06-19","2024-06-22","2024-06-22","2024-06-22","2024-06-22","2024-06-22","2024-06-22","2024-06-22","2024-06-22"],"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":[["","","Triamcinolone Acet 0.1 % Ointment Padagis","","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Ointment Encube","","","Select","Select",""],["","","Simvastatin","40 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Prednisone","10 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Tamsulosin","0.4 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Pfizer-Biontech Gray","","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Doxycycline Hyclate","100 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":""}]}]}