{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carl T Delcoro","gend":0,"currentgend":"","add":"1239 OLD COUNTY RD","city":"WALDOBORO","state":"ME","zip":"04572","dob":"1951-09-05","age":"","mstatus":"","insh":"10000053617","cliId":"","pno":"2075636933","cno":"2072309576","email":"dpuddlefarm@gmail.com","ename":"","eno":"","pphy":"WORTHING, ERIC N","ppno":"2075634250","pcpadd":"24 MILES CENTER WAY,","pcpcity":"DAMARISCOTTA","pcpstate":"ME","pcpzip":"45434047","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1239 OLD COUNTY RD","madd2":"","madd3":"","mcity":"WALDOBORO","mstate":"ME","mzip":"04572","pcpfaxno":"2075634246","pcpnpi":"1639431414","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5QQ3XK6FG86","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H2511","R6889","B079","R350","M48062","F5101","H4489","I700","J449","C6932","D329","D120","C439","K7689","N281","N200","Z86010","D122","D124","K8689","D320","I6782","K861","K2960","M5126","M5137","M47817","Z1211","M48061","B9681","C259","R0609","R9431","I5189","F1091","K6389","Z4682","G8918","A000","C258","T8119XA","C252","Z23","Z5111","M5117","M4727","M4316","C257","Z803","C4330","Z452","K769","M5416","F411","E1142","E1165","Z483","M419","M51362","K5730","R911","R7309","Z9001","I2510","M51360","M5441","R059","R051","R0602"],"date":["2023-04-07","2023-11-29","2023-04-27","2023-06-14","2025-07-11","2024-02-01","2025-09-16","2023-11-20","2023-11-20","2025-03-03","2024-03-11","2024-03-26","2024-03-29","2024-04-05","2025-08-04","2025-08-04","2024-03-26","2024-03-26","2024-03-26","2024-07-30","2024-04-05","2024-04-05","2024-04-18","2024-04-18","2024-04-22","2024-04-22","2025-07-11","2024-03-26","2024-04-22","2024-04-18","2026-02-20","2024-06-05","2024-06-05","2024-06-26","2024-06-04","2024-06-29","2024-06-28","2024-06-30","2024-07-03","2024-06-27","2024-06-26","2024-06-25","2025-09-25","2025-01-29","2025-09-02","2025-09-02","2025-09-02","2024-09-03","2024-09-03","2024-09-03","2025-02-11","2024-08-06","2026-02-19","2025-03-04","2025-02-26","2024-11-19","2024-08-02","2026-01-09","2026-01-09","2025-08-04","2025-02-05","2024-09-24","2025-09-23","2026-02-18","2025-07-11","2025-09-02","2025-03-12","2024-01-03","2025-03-12"],"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":[["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","METRONIDAZOLE","250 MG","","Select","Select",""],["","","TOBRADEX","","","Select","Select",""],["","","CAPECITABINE","500 MG","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","Onetouch Ultra 2","","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","ONETOUCH ULTRA","","","Select","Select",""],["","","ROSUVASTATIN","10 MG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","ONDANSETRON","8 MG","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","LISINOPRIL","2.5 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","Glipizide","5 MG","","Select","Select",""],["","","MELOXICAM","15 MG","","Select","Select",""],["","","TETRACYCLINE","500 MG","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","DOXEPIN","10 MG","","Select","Select",""],["","","PROCHLORPERAZINE","5 MG","","Select","Select",""],["","","Erythromycin 0.5 % Ophth Oint B&L","","","Select","Select",""],["","","Dexcom G7 Sensor","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","LEVOFLOXACIN","750 MG","","Select","Select",""],["","","ONETOUCH DELICA PLUS","","","Select","Select",""],["","","HYDROCODONE\/ACETAMINOPHEN","5\/325 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","CITALOPRAM","10 MG","","Select","Select",""],["","","DEXCOM G","","","Select","Select",""],["","","ERYTHROMYCIN","0.005","","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":""}]}]}