{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Larry G Poulin","gend":0,"currentgend":"","add":"115 POULIN DR","city":"READFIELD","state":"ME","zip":"04355","dob":"1952-12-05","age":"","mstatus":"","insh":"10000058435","cliId":"","pno":"2074587124","cno":"2072152933","email":"Larrypoulin115@gmail.com","ename":"","eno":"","pphy":"MURPHY, ROCHELLE S","ppno":"2076243800","pcpadd":"Winthrop Family Medicine,149 Main St","pcpcity":"Winthrop","pcpstate":"ME","pcpzip":"04364","pcpcounty":"","pcpid":"","pcpname":"WINTHROP FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 189","madd2":"","madd3":"","mcity":"READFIELD","mstate":"ME","mzip":"04355","pcpfaxno":"2076243845","pcpnpi":"1245585108","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3YG5Q70AX52","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","H35013","M79672","M79671","D210","D649","E785","Z0000","D709","B351","D539","R6889","R059","I2510","K529","D6489","D469","J90","Z951","D72819","I9789","I4891","D4620","Z79899","R0989","R0602","Z01810","R079","G4730","R778","K5289","D46B","R5383","I340","I10","Z48812","J9811","M19071","R9431","D531","I2584","I517","R700","I6523","R140","Z98890","I25118","M25571","R109","F1090","H538","Z4682","M25532","W19XXXA","X500XXA","J069","M19032","M7989"],"date":["2026-02-04","2023-05-05","2023-06-06","2023-06-06","2023-06-06","2025-09-24","2023-06-14","2025-07-07","2024-06-18","2023-06-21","2025-09-10","2023-07-26","2025-03-25","2025-06-05","2024-11-07","2025-09-10","2026-03-03","2025-05-01","2025-08-01","2025-09-10","2025-05-14","2025-05-14","2026-02-17","2026-03-03","2026-02-04","2025-04-10","2025-04-10","2025-04-10","2025-04-11","2025-07-28","2024-11-11","2025-10-21","2025-09-23","2025-04-11","2025-04-11","2025-05-01","2025-05-01","2025-11-20","2025-03-24","2025-09-02","2025-04-10","2025-04-10","2025-03-25","2025-04-10","2025-04-15","2025-04-15","2025-04-11","2025-11-17","2024-11-07","2025-09-02","2025-05-23","2025-04-16","2023-02-08","2023-02-08","2023-02-08","2023-02-08","2023-02-08","2023-02-08"],"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",""],["","","ATORVASTATIN","80 MG","","Select","Select",""],["","","COLCHICINE","0.6 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE","","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","METRONIDAZOLE","500 MG","","Select","Select",""],["","","METOPROLOL TART","25 MG","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","POTASSIUM CL","20 MEQ","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","NITROGLYCERIN","0.4 MG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","AMIODARONE","200 MG","","Select","Select",""],["","","CYCLOBENZAPRINE","5 MG","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","TERBINAFINE","250 MG","","Select","Select",""],["","","FLUAD QUAD","","","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":""}]}]}