{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ronald C Smith","gend":0,"currentgend":"","add":"23 MONK RD","city":"BRIDGTON","state":"ME","zip":"04009","dob":"1943-07-02","age":"","mstatus":"","insh":"10000061634","cliId":"","pno":"2076472609","cno":"","email":"declined@01032026.com","ename":"","eno":"","pphy":"PIERKO, DARIUSZ R","ppno":"2076479021","pcpadd":"North Bridgton Family Practice,14 Wyonegonic Rd","pcpcity":"North Bridgton","pcpstate":"ME","pcpzip":"04057","pcpcounty":"","pcpid":"","pcpname":"NORTH BRIDGTON FAMILY PRACTICE AND WALK IN CLINIC","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"23 MONK RD","madd2":"","madd3":"","mcity":"BRIDGTON","mstate":"ME","mzip":"04009","pcpfaxno":"2076475932","pcpnpi":"1417074188","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9AN2WQ5QJ06","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E119","R42","L989","H353112","H353123","H40013","H04123","L03114","R6889","L602","M79674","M79675","L570","D485","L814","D225","L821","C44629","G5601","G5621","M542","Z4789","H4322","M5412","E1140","L600","E1149","L905","T8140XA","H353133","I2510","E785","R296"],"date":["2024-04-02","2024-06-10","2023-06-01","2023-05-17","2023-05-17","2024-05-13","2023-11-13","2023-06-06","2023-06-02","2023-06-27","2023-06-27","2023-06-27","2023-10-17","2023-10-17","2023-07-11","2023-07-11","2023-07-11","2023-12-18","2023-10-19","2023-10-19","2024-04-30","2023-10-19","2023-11-13","2024-05-01","2024-04-17","2024-01-08","2024-05-29","2024-01-31","2023-12-28","2024-07-11","2024-02-20","2024-06-20","2024-04-22"],"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":[["","","Janumet","","","Select","Select",""],["","","Soliqua 100\/33","","","Select","Select",""],["","","Mupirocin 2 % Ointment Padagis","","","Select","Select",""],["","","Bd Nano 2 Gen","","","Select","Select",""],["","","Super Thin (Ref At 0535Ah)","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Embecta Nano 2Nd Gen (Ref 320550)","","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","Onetouch Ultra","","","Select","Select",""],["","","Amlodipine","10 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Onetouch Ultra Blue","","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Glipizide","5 MG","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 MG","","Select","Select",""],["","","Losartan\/Hydrochlorothiazide","100\/25 MG","","Select","Select",""],["","","Trazodone","150 MG","","Select","Select",""],["","","Rosuvastatin","20 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":""}]}]}