{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert L Gove","gend":0,"currentgend":"","add":"27 BAKER RD","city":"WINDSOR","state":"ME","zip":"04363","dob":"1952-07-29","age":"","mstatus":"","insh":"10000055761","cliId":"","pno":"2074418975","cno":"","email":"tackerbob@roadrunner.com","ename":"","eno":"","pphy":"HOKE, ABIGAIL","ppno":"2075826608","pcpadd":"Gardiner Family Medicine,5 Central Maine Crossing","pcpcity":"Gardiner","pcpstate":"ME","pcpzip":"04345","pcpcounty":"","pcpid":"","pcpname":"GARDINER FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"27 BAKER RD","madd2":"","madd3":"","mcity":"WINDSOR","mstate":"ME","mzip":"04363","pcpfaxno":"2075822258","pcpnpi":"1740576495","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8U61P40HJ02","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E113511","Z794","H40053","E113312","E1151","Z0100","B351","L602","Z7984","I6523","R42","R112","I10","I639","R030","J323","R2689","Z743","H26491","I160","E1165","E785","H903","H6120","H90A22","I161","R011","H9192","E113591","E1137X1","H905","E113313","H04123","E119","M25562","R0789","I739","M79605","R040","R809"],"date":["2023-08-04","2024-03-22","2024-05-10","2023-12-08","2024-04-22","2024-06-21","2023-05-19","2023-05-19","2023-05-19","2023-07-08","2023-08-08","2023-07-08","2024-02-02","2023-07-09","2023-07-09","2023-07-09","2023-07-12","2024-01-30","2023-08-04","2023-07-10","2023-07-10","2023-07-10","2023-08-01","2023-08-08","2023-08-08","2023-07-08","2023-10-20","2023-08-21","2023-09-15","2023-09-15","2023-10-26","2024-03-22","2024-05-10","2024-01-31","2023-10-20","2023-10-20","2024-01-31","2024-01-31","2024-01-30","2024-05-07"],"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":[["","","Jardiance","","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Freestyle Lite","","","Select","Select",""],["","","Bd Nano 2 Gen","","","Select","Select",""],["","","Embecta Nano 2Nd Gen (Ref 320550)","","","Select","Select",""],["","","Glipizide","5 MG","","Select","Select",""],["","","Amlodipine","10 MG","","Select","Select",""],["","","Freestyle","","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Cilostazol","100 MG","","Select","Select",""],["","","Clotrimazole 1 % Cream Taro","","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Nano (Ref 320122)","","","Select","Select",""],["","","Ozempic","","","Select","Select",""],["","","Lantus Solostar","","","Select","Select",""],["","","Labetalol","200 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":""}]}]}