{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David A King","gend":0,"currentgend":"","add":"38 NASON ROAD","city":"Gorham","state":"ME","zip":"04038","dob":"1953-01-30","age":"","mstatus":"","insh":"10000071323","cliId":"","pno":"2072290421","cno":"","email":"dking@temmachining.com","ename":"","eno":"","pphy":"CAREY, SEAN P","ppno":"2078392559","pcpadd":"Martins Point Health Care,575 Main St","pcpcity":"Gorham","pcpstate":"ME","pcpzip":"04038","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"38 NASON ROAD","madd2":"","madd3":"","mcity":"Gorham","mstate":"ME","mzip":"04038","pcpfaxno":"2075231135","pcpnpi":"1447328125","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6X80XC5UX15","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E785","Z125","Z1159","M810","Z23","M5412","R221","M5011","M4722","D171","E806","E039","R7401","I4719","R0602","I491","I081","R002"],"date":["2024-05-13","2023-11-14","2023-11-14","2023-11-14","2024-01-25","2023-12-07","2023-12-07","2023-12-07","2023-12-07","2024-01-16","2024-01-23","2024-01-23","2024-01-30","2024-05-13","2024-05-13","2024-05-13","2024-05-29","2024-05-30"],"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":[["","","Prednisone","20 MG","","Select","Select",""],["","","Advair Diskus","","","Select","Select",""],["","","Rosuvastatin","20 MG","","Select","Select",""],["","","Atovaquone\/Proguanil","250\/100 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Famotidine","20 MG","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 MG","","Select","Select",""],["","","Alprazolam","0.5 MG","","Select","Select",""],["","","Chlorhexidine 0.12 % Oral Rinse Xttrium","","","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":""}]}]}