{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ervin E Mullett","gend":0,"currentgend":"","add":"11 B BIRCHWOOD RD","city":"Woolwich","state":"ME","zip":"04579","dob":"1949-05-29","age":"","mstatus":"","insh":"10000054433","cliId":"","pno":"2073184849","cno":"","email":"emullett385@gmail.com","ename":"","eno":"","pphy":"STEELE, ERIK N","ppno":"","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":"11 B BIRCHWOOD RD","madd2":"","madd3":"","mcity":"Woolwich","mstate":"ME","mzip":"04579","pcpfaxno":"2078287850","pcpnpi":"1538176789","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6NX1JF2XM06","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":["M461","M5416","M5450","M25551","M533","M7061","M47816","M9903","M5431","M9904","M5430","I7140","M5126","M5020","I10","E785","G8918","E7800","H6121","Z23","G5701","M7601","S76011A","R059","B379","R0689","R5381","N471","N476","M9902","M546","M9901","M542"],"date":["2023-08-09","2023-06-12","2023-06-05","2024-01-23","2023-04-28","2024-01-23","2023-06-22","2023-08-09","2023-08-09","2023-08-09","2023-07-12","2023-08-04","2024-01-10","2023-08-14","2023-10-10","2023-08-14","2023-08-14","2023-10-10","2023-10-17","2023-10-17","2023-11-29","2024-03-20","2024-01-23","2024-02-20","2024-03-05","2024-02-20","2024-02-20","2024-03-06","2024-03-14","2024-06-25","2024-06-25","2024-06-25","2024-06-25"],"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":[["","","Mupirocin 2 % Ointment Teva","","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Mupirocin 2 % Ointment Taro","","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Doxycycline Monohydrate","100 MG","","Select","Select",""],["","","Atorvastatin","80 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Clotrim\/Betameth Diprop 1\/0.05 % Cream Fou","","","Select","Select",""],["","","Bupropion Hcl","150 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Ointment Macleods","","","Select","Select",""],["","","Tamsulosin","0.4 MG","","Select","Select",""],["","","Gabapentin","300 MG","","Select","Select",""],["","","Sertraline","100 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Boostrix","","","Select","Select",""],["","","Tramadol","50 MG","","Select","Select",""],["","","Clopidogrel","75 MG","","Select","Select",""],["","","Lisinopril","40 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":""}]}]}