{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Bartley S Haseltine","gend":0,"currentgend":"","add":"8 WESCOTT AVE","city":"BAR HARBOR","state":"ME","zip":"04609","dob":"1952-05-15","age":"","mstatus":"","insh":"10000067280","cliId":"","pno":"2072884749","cno":"2078018300","email":"scottman2@msn.com","ename":"","eno":"","pphy":"MURPHY, GORDON D","ppno":"2072885119","pcpadd":"Cadillac Family Practice,322 Main St","pcpcity":"Bar Harbor","pcpstate":"ME","pcpzip":"04609","pcpcounty":"","pcpid":"","pcpname":"CADILLAC FAMILY PRACTICE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"8 WESCOTT AVE","madd2":"","madd3":"","mcity":"BAR HARBOR","mstate":"ME","mzip":"04609","pcpfaxno":"2072888449","pcpnpi":"1801027164","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2XE5M42JU97","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1711","M79672","M7662","Z0000","I350","I352","R0600","I517","I2510","I429","E119","A419","I480","R109","B3742","R053","D122","K621","I10","Z7982","K3189","I739","J90","R0602","I6523","I7143","R079","Z950","Z09","M25551","I5030","M25512","I351","Z0001","D589","I469","K8050","Z4682","E113291","M5450","A4189","Z789","I4901","K922","Z953","L281","L280","Z4502","H532","M48062","M47816","I25118","G6289","R0609","R200","M549","I39","Z006","I5032","N472","K819","I7140","R351","D649","K625","D500","Z139","K828","R160","J9811","R0789","R000","I130","R930","I77810","I499","Z9989","Z1211","D120"],"date":["2023-12-26","2023-05-11","2023-07-31","2024-08-29","2025-12-22","2025-05-28","2024-03-13","2024-08-06","2025-12-09","2025-08-12","2025-09-12","2025-10-11","2026-02-02","2025-05-28","2025-11-03","2025-05-05","2025-11-06","2025-11-06","2025-09-09","2025-09-09","2025-10-14","2025-02-27","2025-12-31","2025-12-31","2025-06-05","2025-05-28","2025-05-28","2025-12-31","2025-11-06","2025-11-10","2026-01-20","2025-02-06","2024-08-06","2025-09-02","2026-03-03","2026-01-07","2026-02-25","2025-12-27","2026-01-27","2025-02-06","2025-10-12","2025-10-12","2026-01-07","2025-10-24","2025-10-21","2024-10-18","2024-10-18","2026-01-13","2026-01-05","2025-11-20","2025-11-20","2025-04-07","2025-12-15","2025-03-24","2025-11-20","2025-11-10","2025-11-10","2025-08-12","2025-08-12","2026-02-12","2025-10-14","2026-01-16","2025-12-08","2026-03-02","2026-02-04","2025-10-25","2025-12-08","2025-10-12","2025-10-12","2025-12-30","2025-10-11","2025-10-11","2026-01-30","2025-12-27","2025-12-16","2025-12-27","2025-12-27","2023-02-27","2023-02-27"],"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":[["","","Clotrim\/Betameth Diprop 1\/0.05 % Cream Act","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","OSELTAMIVIR","75 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","AMIODARONE","200 MG","","Select","Select",""],["","","CARVEDILOL","12.5 MG","","Select","Select",""],["","","ROSUVASTATIN","10 MG","","Select","Select",""],["","","METOPROLOL SUCC","25 MG","","Select","Select",""],["","","CEFPODOXIME","200 MG","","Select","Select",""],["","","ZOLPIDEM","5 MG","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","AMLODIPINE","5 MG","","Select","Select",""],["","","Betamethasone Diprop 0.05 % Cream Fougera","","","Select","Select",""],["","","BOOSTRIX","","","Select","Select",""],["","","LOSARTAN","25 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","BETAMETHASONE DIPROP","0.0005","","Select","Select",""],["","","CLOTRIM\/BETAMETH DIPROP","1\/0.05 %","","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":""}]}]}