{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Paul B Brown","gend":0,"currentgend":"","add":"1411 WASHINGTON ST","city":"Bath","state":"ME","zip":"04530","dob":"1950-05-26","age":"","mstatus":"","insh":"10000058104","cliId":"","pno":"2075226225","cno":"2078418974","email":"charpa@comcast.net","ename":"","eno":"","pphy":"HJORTH, CHRISTOPHER P","ppno":"2073861800","pcpadd":"Mid Coast Hospital,123 Medical Ctr Dr","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1411 WASHINGTON ST","madd2":"","madd3":"","mcity":"Bath","mstate":"ME","mzip":"04530","pcpfaxno":"","pcpnpi":"1225415482","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2QK1QE1RK05","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25571","M9900","M9901","M9902","M9903","I6523","R9089","I25700","I2584","I77810","I493","I50810","G459","I2510","J449","Z87891","Z0389","R410","J321","Z8673","E782","I7121","I471","I4720","I498","Z0100","M19071","M25871","Z0000","R262","G8929","I358","Q828","D2261","L570","D492","D225","L814","L821","L578","M19079","H40013","R6889","M5441","D3131","H40003","H25813","K5730","K8020","K828","R0989","R079","K819","J45909","E785","K219","K8000","K8010","K82A1"],"date":["2023-11-29","2024-06-10","2024-06-10","2024-06-10","2024-06-10","2023-04-24","2023-04-25","2024-01-16","2023-04-21","2023-04-25","2023-04-21","2023-10-13","2023-05-06","2024-06-17","2024-03-11","2023-04-25","2023-04-24","2023-04-25","2023-04-25","2023-05-10","2024-01-16","2024-06-17","2023-05-24","2023-05-24","2023-05-24","2024-03-06","2023-07-13","2023-07-13","2023-07-13","2023-07-13","2023-11-29","2023-10-13","2023-12-05","2023-12-05","2023-12-05","2023-12-05","2023-12-05","2023-12-05","2023-12-05","2023-12-05","2024-03-11","2024-03-06","2023-01-26","2024-06-10","2024-04-25","2024-04-25","2024-04-25","2024-06-17","2024-06-17","2024-06-17","2024-06-17","2024-06-17","2024-06-18","2024-06-18","2024-06-18","2024-06-18","2024-06-18","2024-06-18","2024-06-18"],"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":[["","","Shingrix","","","Select","Select",""],["","","Clopidogrel","75 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","Rosuvastatin","40 MG","","Select","Select",""],["","","Tamsulosin","0.4 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Metoprolol Succ","25 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","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":""}]}]}