{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Steven E Gaston","gend":0,"currentgend":"","add":"383 SEBAGO LAKE RD","city":"GORHAM","state":"ME","zip":"04038","dob":"1955-01-08","age":"","mstatus":"","insh":"10000074273","cliId":"","pno":"2078930934","cno":"","email":"lcamp29116@aol.com","ename":"","eno":"","pphy":"JOHNSON, ELLIS A","ppno":"2076621340","pcpadd":"1 HARNOIS AVE STE 1B,","pcpcity":"WESTBROOK","pcpstate":"ME","pcpzip":"40924395","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"383 SEBAGO LAKE RD","madd2":"","madd3":"","mcity":"GORHAM","mstate":"ME","mzip":"04038","pcpfaxno":"2076621341","pcpnpi":"1215196985","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2YT7NP2NU30","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5450","T83098A","N390","Z7722","A4102","Z538","T83198A","G35","Z466","I429","I447","I3139","Z0000","E039","K529","G8929","T83511A","G8250","I428","N3090","R269","R1030","R8271","N210","N312","M792","Z23","N3000","N503","N5082","N310","R3129","N401","N2882","N1330","B999","L209","T83518A","G35D","R32","Z87440","N2889","M5416","G8220","Z79899","M5441","N319","Z131","T83511D","E785","Z125","F17200","R4182","M4712","N3289","I10","K5900","N400","K551","M47816","M48061","N10","R7881","B9562","Z452","T8144XA","R6521","A419","R7989","R319","R509","Z720","R109","Z0389","R609","R310","B356"],"date":["2023-04-19","2023-04-24","2025-12-01","2024-09-10","2023-03-24","2023-04-24","2023-04-24","2025-09-10","2026-01-10","2024-10-04","2025-08-12","2025-10-24","2025-09-04","2023-07-19","2023-07-19","2024-12-02","2024-06-19","2023-07-17","2025-10-10","2023-07-17","2023-07-19","2024-06-11","2024-09-13","2025-08-12","2024-07-08","2023-11-20","2023-10-17","2024-02-25","2024-02-24","2024-02-24","2026-02-26","2024-06-03","2024-06-11","2024-06-11","2024-06-11","2024-06-26","2024-06-26","2024-06-11","2026-01-15","2026-02-17","2026-02-17","2025-04-11","2024-12-02","2024-12-02","2025-10-10","2024-10-11","2025-10-30","2025-10-28","2024-07-19","2025-10-28","2025-10-28","2025-08-12","2025-08-12","2025-10-27","2025-10-30","2025-07-27","2025-07-17","2025-07-17","2025-07-17","2024-09-15","2024-09-15","2023-02-28","2023-02-28","2023-02-28","2023-02-27","2023-02-27","2023-02-27","2023-03-01","2023-03-01","2023-02-21","2023-02-21","2023-02-24","2023-02-23","2023-02-21","2023-02-21","2023-02-21","2023-01-19"],"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",""],["","","LEVOFLOXACIN","750 MG","","Select","Select",""],["","","PENICILLIN VK","500 MG","","Select","Select",""],["","","ATORVASTATIN","20 MG","","Select","Select",""],["","","FOSFOMYCIN","3 GM","","Select","Select",""],["","","DALFAMPRIDINE","10 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE","","","Select","Select",""],["","","NITROFURANTOIN MACRO\/MONO","100 MG","","Select","Select",""],["","","OXYBUTYNIN","10 MG","","Select","Select",""],["","","OXCARBAZEPINE","150 MG","","Select","Select",""],["","","SPIKEVAX","","","Select","Select",""],["","","LINEZOLID","600 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","DULOXETINE","20 MG","","Select","Select",""],["","","Mupirocin 2 % Cream Encube","","","Select","Select",""],["","","Mupirocin 2 % Cream Taro","","","Select","Select",""],["","","CIPROFLOXACIN","500 MG","","Select","Select",""],["","","TRAZODONE","150 MG","","Select","Select",""],["","","Clotrim\/Betameth Diprop 1\/0.05 % Cream Fou","","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","CARVEDILOL","6.25 MG","","Select","Select",""],["","","AMPYRA","","","Select","Select",""],["","","Triamcinolone Acet 0.5 % Cream Ascend Labs","","","Select","Select",""],["","","KESIMPTA","","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","METHYLPREDNISOLONE","4 MG","","Select","Select",""],["","","CLOTRIM\/BETAMETH DIPROP","1\/0.05 %","","Select","Select",""],["","","MUPIROCIN","0.02","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.005","","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":""}]}]}