{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Solomon S Goldman","gend":0,"currentgend":"","add":"92 CUMBERLAND ST","city":"BANGOR","state":"ME","zip":"04401","dob":"1949-08-03","age":"","mstatus":"","insh":"10000075735","cliId":"","pno":"2078010189","cno":"2079514874","email":"Goldmans49@hotmail.com","ename":"","eno":"","pphy":"THERMOS, EMILY T","ppno":"2079891567","pcpadd":"Brewer Medical Center,735 Wilson St","pcpcity":"Brewer","pcpstate":"ME","pcpzip":"04412","pcpcounty":"","pcpid":"","pcpname":"BREWER MEDICAL CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"92 CUMBERLAND ST","madd2":"","madd3":"","mcity":"BANGOR","mstate":"ME","mzip":"04401","pcpfaxno":"2079892286","pcpnpi":"1396204707","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3ET4G33JD94","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M9901","M9902","M9903","M9904","M5450","M7910","M533","R21","D72820","D709","D539","D696","B029","C61","C9110","D509","R590","M7989","M79604","R918","N200","R2241","R29898","M5137","M47817","M4316","M4805","M5127","M5136","M47816","R202","Z79899","C9590","R200","M5416","M21371","M48061","G6289","Z856","R600","D649","Z23","R9389","R937","Z13820","M21379","G629","I890","M8588","Z0101","H5213","R6889","B0229","L282","M542","E785","I10","E559","R739"],"date":["2023-08-04","2023-08-04","2023-08-04","2023-08-04","2023-08-04","2023-08-04","2023-08-04","2023-08-07","2023-08-07","2023-08-07","2023-08-07","2023-08-07","2023-08-14","2024-05-24","2024-05-29","2023-08-16","2023-08-16","2023-08-25","2023-12-12","2023-08-25","2023-08-25","2023-08-25","2023-09-15","2023-08-29","2023-09-28","2023-09-28","2023-09-11","2023-09-11","2023-09-28","2023-09-11","2023-09-28","2023-08-31","2023-09-26","2023-09-28","2023-10-05","2023-09-28","2023-09-28","2023-10-11","2023-10-11","2023-08-30","2023-08-30","2023-10-17","2023-10-19","2023-10-19","2023-10-19","2023-10-25","2023-10-25","2023-10-03","2023-10-19","2023-11-10","2023-11-10","2023-12-07","2023-11-14","2024-03-13","2023-12-28","2024-03-12","2024-03-12","2024-03-12","2024-03-12"],"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":[["","","Furosemide","20 MG","","Select","Select",""],["","","Doxycycline Monohydrate","100 MG","","Select","Select",""],["","","Moxifloxacin 0.5 % Ophth Sol Fosun","","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","Gabapentin","400 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Lupin","","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Tramadol","50 MG","","Select","Select",""],["","","Atorvastatin","10 MG","","Select","Select",""],["","","Ketorolac 0.4 % Ophth Sol Pacific","","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Allopurinol","300 MG","","Select","Select",""],["","","Losartan","50 MG","","Select","Select",""],["","","Meloxicam","7.5 MG","","Select","Select",""],["","","Valacyclovir","1 GM","","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":""}]}]}