{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Eddie A Mains","gend":0,"currentgend":"","add":"45 DENALI TRL","city":"BUXTON","state":"ME","zip":"04093","dob":"1954-02-16","age":"","mstatus":"","insh":"10000076069","cliId":"","pno":"2073294290","cno":"","email":"chicridgerunner@icloud.com","ename":"","eno":"","pphy":"HA NGOC, TIN","ppno":"","pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"45 DENALI TRL","madd2":"","madd3":"","mcity":"BUXTON","mstate":"ME","mzip":"04093","pcpfaxno":"2078287850","pcpnpi":"1073877791","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7CR3G39KA72","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":["M9902","M62830","M9903","M549","R7301","W57XXXA","E785","Z0101","H903","K5190","L821","D225","Z85828","Z85820","Z836","M9904","M9901","G5602","R059","M25562","L570","H2511","I25119","I9789","I4891","H524","M5459","Z951","R0789","M9900","H2513","D649","I517","I5189","R931","I5021","Z48812","J984","R0989","I214","J90","I351","E669","R4182","Z95811","I2109","I082","I499","Z1211","H2512","I213","R079","Z4509","J9811","Z130","Z125","Z09","I6523","Z471","Z96652","K5150"],"date":["2025-08-19","2023-05-20","2025-08-19","2023-05-20","2025-10-03","2023-08-21","2025-10-03","2025-11-25","2023-12-19","2023-12-12","2026-01-27","2024-01-23","2026-01-27","2026-01-27","2024-08-07","2025-05-07","2025-08-19","2024-05-28","2024-06-28","2025-11-13","2026-01-27","2024-12-16","2025-11-24","2025-11-24","2025-11-24","2025-11-25","2025-05-07","2025-10-02","2025-08-19","2025-08-19","2024-11-21","2025-11-18","2025-12-22","2025-12-22","2025-12-22","2025-12-22","2025-08-28","2025-08-21","2025-08-20","2025-08-17","2025-08-24","2025-08-18","2025-08-18","2025-08-18","2025-08-18","2025-08-19","2025-08-17","2025-08-17","2025-01-02","2024-12-16","2025-08-28","2025-08-17","2025-08-19","2025-09-30","2025-10-03","2025-10-03","2025-08-19","2025-08-17","2025-11-13","2025-11-13","2025-01-02"],"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","5 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","ROSUVASTATIN","40 MG","","Select","Select",""],["","","EZETIMIBE","10 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","POTASSIUM CL","20 MEQ","","Select","Select",""],["","","AMIODARONE","200 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":""}]}]}