{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Stephen D Bruneau","gend":0,"currentgend":"","add":"31 OAKWOOD DR","city":"TURNER","state":"ME","zip":"04282","dob":"1952-07-04","age":"","mstatus":"","insh":"10000058586","cliId":"","pno":"2072240087","cno":"2072240087","email":"declined@10212024.com","ename":"","eno":"","pphy":"RIVARD, GARY S","ppno":"2075243501","pcpadd":"180 CHURCH HILL RD,STE 1","pcpcity":"LEEDS","pcpstate":"ME","pcpzip":"42633418","pcpcounty":"","pcpid":"","pcpname":"DFD RUSSELL MEDICAL CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"31 OAKWOOD DR","madd2":"","madd3":"","mcity":"TURNER","mstate":"ME","mzip":"04282","pcpfaxno":"2076476015","pcpnpi":"1194801993","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6KJ2E99FR99","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","E11621","S99922A","L03116","S80812A","L97529","I70245","E1151","I96","L97422","L97524","E13621","I70263","I70262","E08621","I70244","S91302D","I739","E162","E119","D649","E785","Z8614","I70202","E1152","I998","I70213","I7092","Z89512","I70261","M7989","M19071","R0902","R0602","M86171","I2510","R9431","D62","N179","L97519","Z4781","Z89519","Z794","R4182","R569","R1011","Z136","Z87891","R059","J811","R4020","I469","N289","Z0000","Z125"],"date":["2025-12-19","2024-03-24","2023-06-20","2023-06-27","2023-06-27","2023-08-04","2023-12-14","2023-08-04","2024-03-24","2023-07-25","2023-07-10","2023-06-28","2023-06-28","2023-06-28","2023-07-25","2023-12-14","2023-08-01","2024-03-19","2025-02-21","2025-12-19","2023-09-18","2024-09-19","2023-09-18","2023-07-06","2024-04-12","2024-03-24","2024-02-19","2024-03-04","2024-03-04","2024-03-23","2024-03-19","2024-03-19","2024-03-19","2024-03-23","2024-03-23","2024-03-24","2024-03-19","2024-03-23","2024-03-23","2024-03-21","2024-04-12","2024-04-23","2023-06-20","2025-02-11","2025-02-11","2026-01-14","2026-01-14","2026-01-14","2024-12-01","2025-02-11","2025-02-10","2025-02-10","2025-11-13","2025-08-25","2025-08-19"],"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",""],["","","Mupirocin 2 % Ointment Padagis","","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","SERTRALINE","100 MG","","Select","Select",""],["","","Metoprolol Tart","100 MG","","Select","Select",""],["","","ROSUVASTATIN","40 MG","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","BETHANECHOL","25 MG","","Select","Select",""],["","","TAMSULOSIN","0.4 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","BENAZEPRIL","10 MG","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","MUPIROCIN","0.02","","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":""}]}]}