{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Stephen A Robichaud","gend":0,"currentgend":"","add":"103 ST CROIX ST","city":"LEWISTON","state":"ME","zip":"04240","dob":"1953-09-20","age":"","mstatus":"","insh":"10000071272","cliId":"","pno":"2073123006","cno":"","email":"","ename":"","eno":"","pphy":"BEGGS, ALEX W","ppno":"2077955700","pcpadd":"12 HIGH ST,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407676","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 2135","madd2":"","madd3":"","mcity":"LEWISTON","mstate":"ME","mzip":"04241","pcpfaxno":"2077955727","pcpnpi":"1750862769","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3UN1DP3KF23","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25552","L920","Z96652","Z96651","M1612","M25562","G8929","R6889","Z0000","I10","Z8619","K8020","I7140","F17210","E6601","R2231","F1020","Z87891","Z122","Z471","Z96642","R600","N2889","S72142D","S72115D","R0609","R053","M879","Z4789","R338","N401","Z01818","C642","R9720","M87052","R21","R197","I2510","J439","I4891","D600","R609","Z79899","I7143","M1990","M9702XA","I700","I493","I083","I517","I5189"],"date":["2024-10-23","2023-07-13","2023-08-02","2023-08-02","2024-09-30","2024-06-07","2024-06-07","2023-01-02","2025-12-19","2026-02-18","2023-12-14","2023-12-14","2025-12-31","2024-06-12","2024-03-12","2024-06-07","2025-12-18","2025-12-31","2024-06-12","2025-09-24","2025-09-24","2024-10-15","2026-01-21","2024-12-23","2024-11-20","2024-06-15","2024-06-15","2024-09-26","2024-12-23","2024-10-01","2024-09-26","2024-09-23","2026-01-21","2026-01-13","2024-09-26","2024-10-10","2024-10-01","2024-08-07","2026-02-18","2026-02-18","2024-10-15","2024-10-15","2025-10-01","2026-02-11","2024-10-14","2024-11-11","2025-12-31","2026-02-11","2026-02-12","2026-02-12","2026-02-12"],"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","10 MG","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","CEFADROXIL","500 MG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","TAMSULOSIN","0.4 MG","","Select","Select",""],["","","Metoprolol Tart","50 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","MELOXICAM","7.5 MG","","Select","Select",""],["","","CIPROFLOXACIN","500 MG","","Select","Select",""],["","","Clotrim\/Betameth Diprop 1\/0.05 % Cream Fou","","","Select","Select",""],["","","Boostrix","","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Eliquis","","","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":""}]}]}