{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John A Philbrook","gend":0,"currentgend":"","add":"450 FORD QUINT RD","city":"NORTH BERWICK","state":"ME","zip":"03906","dob":"1952-11-02","age":"","mstatus":"","insh":"10000073293","cliId":"","pno":"2073242468","cno":"","email":"jphilbro@maine.rr.com","ename":"","eno":"","pphy":"MALONSO, RESTITUTO D","ppno":"6036096800","pcpadd":"Strafford Medical Associates,10 Members Way Ste 500","pcpcity":"Dover","pcpstate":"NH","pcpzip":"03820","pcpcounty":"","pcpid":"","pcpname":"WHP INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"450 FORD QUINT RD","madd2":"","madd3":"","mcity":"NORTH BERWICK","mstate":"ME","mzip":"03906","pcpfaxno":"","pcpnpi":"1760470975","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1M83JF2VH73","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B9681","K760","K219","E7849","K7581","I480","Z7901","Z9229","Z98890","C61","R350","Z112","K7401","R0789","K2970","K31A0","K3189","K2950","K31A11","K31A15","N401","M75110","Z23","Z0000","R6889","M65352","E7800","M19012","M19011","I4891","R12","R5383","R0600","U071","M6530","R09A2","R0981","R065","G4734","I517","R001","R9430","R079","R0683","M65342","M65322","M25511","G4733","I10","R110","R9439","L578","X32XXXA","L814","D1801","L570","N3281","R399"],"date":["2023-04-12","2024-03-14","2024-04-15","2023-04-12","2023-05-04","2024-04-25","2024-02-26","2023-05-22","2023-10-11","2024-05-03","2024-06-25","2023-04-21","2023-05-04","2023-06-26","2023-07-10","2023-07-10","2023-07-10","2023-07-10","2023-07-10","2023-07-10","2024-05-15","2023-09-26","2023-09-27","2023-09-27","2023-12-24","2023-11-21","2023-09-27","2023-09-26","2023-09-26","2023-10-02","2023-10-02","2023-09-28","2023-10-11","2023-10-11","2023-10-19","2024-04-15","2023-10-20","2023-10-20","2023-10-24","2023-11-14","2023-11-14","2023-11-14","2023-11-14","2023-12-27","2023-11-21","2023-11-21","2023-12-07","2024-06-24","2024-04-25","2024-01-04","2024-02-26","2024-04-25","2024-04-25","2024-04-25","2024-04-25","2024-04-25","2024-05-30","2024-06-07"],"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":[["","","Myrbetriq","","","Select","Select",""],["","","Lovastatin","40 MG","","Select","Select",""],["","","Omeprazole","10 MG","","Select","Select",""],["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Lorazepam","1 MG","","Select","Select",""],["","","Trazodone","50 MG","","Select","Select",""],["","","Gemtesa","","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Famotidine","40 MG","","Select","Select",""],["","","Doxycycline Monohydrate","100 MG","","Select","Select",""],["","","Amlodipine","10 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Finasteride","5 MG","","Select","Select",""],["","","Tamsulosin","0.4 MG","","Select","Select",""],["","","Trimethoprim","100 MG","","Select","Select",""],["","","Losartan","100 MG","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Flulaval Trivalent 2024-2025","","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 MG","","Select","Select",""],["","","Rosuvastatin","20 MG","","Select","Select",""],["","","Telmisartan","80 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":""}]}]}