{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Roger H Pease","gend":0,"currentgend":"","add":"302 MAIN ST","city":"CORNISH","state":"ME","zip":"04020","dob":"1944-10-09","age":"","mstatus":"","insh":"10000063573","cliId":"","pno":"2076254008","cno":"","email":"declined@09302025.com","ename":"","eno":"","pphy":"ROYER, GENE M","ppno":"2076258126","pcpadd":"253 BRIDGTON RD,","pcpcity":"FRYEBURG","pcpstate":"ME","pcpzip":"40371438","pcpcounty":"","pcpid":"","pcpname":"SACOPEE VALLEY HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"302 MAIN ST","madd2":"","madd3":"","mcity":"CORNISH","mstate":"ME","mzip":"04020","pcpfaxno":"2076257820","pcpnpi":"1992776017","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4AN4Q73FK07","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C671","N402","C678","Z0000","Z0101","G8918","J449","E785","E119","K8020","K769","N3289","K5730","R300","R066","I110","I509","I2510","K8050","D090","K8070","I10","Z4889","K8064","R051","R509","N400","E1165","R011","I350","H6690","L03032","Z125","Z79899","R899","I255","J9601","J441","R0602","K635","I080","T148XXA","R918","K921","K2289","Z8639","Z0389","I4819","J984","R0689","D62","I739","R058","Z713","Z6822","L97529","J1000","Z951","Z6823","I2699","I4710","I4720","I498","R059","I96","L089","J929","J069"],"date":["2023-09-15","2023-07-21","2024-08-19","2023-07-31","2025-09-23","2023-09-19","2023-12-08","2025-03-27","2023-09-19","2023-09-19","2023-09-19","2023-09-18","2023-09-19","2023-09-18","2023-09-19","2023-09-15","2023-09-15","2025-03-27","2023-12-08","2023-09-15","2023-12-08","2026-02-24","2023-12-19","2023-12-08","2024-01-05","2024-01-05","2024-02-14","2026-01-09","2024-03-18","2025-12-12","2024-07-09","2024-07-31","2025-08-18","2025-08-18","2026-01-09","2025-09-09","2025-02-13","2025-02-13","2025-12-11","2025-10-25","2025-09-09","2024-08-15","2025-10-23","2025-12-11","2025-10-25","2024-08-15","2024-08-07","2025-10-16","2025-02-27","2025-02-27","2025-10-23","2024-09-04","2026-02-24","2026-02-24","2026-02-24","2024-09-04","2025-02-13","2025-09-09","2026-01-19","2025-02-13","2025-09-22","2025-09-22","2025-09-22","2025-02-13","2024-12-12","2024-08-07","2025-12-11","2023-03-03"],"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":[["","","Triamcinolone Acet 0.025 % Cream Fougera","","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","LISINOPRIL","5 MG","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","METOPROLOL SUCC","25 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","AFLURIA","","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","METOCLOPRAMIDE","5 MG","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","ATORVASTATIN","80 MG","","Select","Select",""],["","","OSELTAMIVIR","45 MG","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.00025","","Select","Select",""],["","","PREVNAR","","","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":""}]}]}