{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Anthony A Grassi","gend":0,"currentgend":"","add":"8 ROGERS RD APT 208","city":"FREEPORT","state":"ME","zip":"04032","dob":"1957-11-13","age":"","mstatus":"","insh":"10000085186","cliId":"","pno":"2073195601","cno":"","email":"tonygrassi1205@gmail.com","ename":"","eno":"","pphy":"LOISELLE, DANIEL","ppno":"2077745816","pcpadd":"100 FODEN ROAD WEST,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"8 ROGERS RD APT 208","madd2":"","madd3":"","mcity":"FREEPORT","mstate":"ME","mzip":"04032","pcpfaxno":"2078741483","pcpnpi":"1316906589","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5WW4NJ6RQ90","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25551","M6281","R262","Z0001","E782","L4050","E538","E1159","G510","R29810","L679","B0221","C9110","R61","I10","Z856","G610","Z0100","E1169","N528","H02231","H16211","H02533","D3161","G629","H0589","N200","K5730","E1142","L4059","D899","J189","R0789","N522","G894","N529","M7989","E279","R399","R109","R202","L400","L218","J984","R051","Z03818","D3162","F419","E785","J40","L304","G9389","R0600","H02409","R0602","J101","F411","H6121","R053","J929","Z87891","R4182","R7989","R000","K130"],"date":["2024-02-02","2024-02-02","2024-02-02","2026-02-13","2024-02-09","2024-02-09","2024-11-04","2025-08-05","2025-10-06","2024-02-15","2024-02-15","2025-02-10","2026-01-22","2026-01-22","2025-08-25","2024-10-01","2024-02-15","2024-04-08","2024-05-03","2024-06-26","2024-06-28","2024-06-28","2024-06-28","2025-10-20","2024-06-26","2024-12-06","2024-08-13","2024-08-13","2025-10-06","2025-10-16","2024-11-15","2025-11-20","2025-11-20","2024-10-10","2024-08-06","2025-08-05","2025-10-20","2026-01-22","2024-08-13","2024-08-13","2025-10-16","2025-10-16","2025-10-16","2025-11-16","2025-11-16","2025-11-16","2025-10-20","2025-10-20","2025-10-20","2024-11-08","2024-11-22","2024-11-15","2024-10-10","2024-10-10","2025-08-04","2025-01-28","2025-07-08","2025-02-07","2025-01-20","2024-10-01","2025-08-25","2025-08-25","2024-10-01","2025-08-04","2025-02-06"],"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":[["","","Tacrolimus 0.1 % Ointment Padagis","","","Select","Select",""],["","","METOPROLOL SUCC","100 MG","","Select","Select",""],["","","TRAZODONE","50 MG","","Select","Select",""],["","","Ketoconazole 2 % Cream Encube","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","PREDNISONE","5 MG","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","12.5 MG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","IRBESARTAN","300 MG","","Select","Select",""],["","","ALPRAZOLAM","1 MG","","Select","Select",""],["","","ALLOPURINOL","300 MG","","Select","Select",""],["","","Tobramycin\/Dex 0.3\/0.1 % Ophth Susp Sandoz","","","Select","Select",""],["","","TAMSULOSIN","0.4 MG","","Select","Select",""],["","","HYDROXYZINE HCL","25 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","LOSARTAN","100 MG","","Select","Select",""],["","","FLUCONAZOLE","200 MG","","Select","Select",""],["","","Tacrolimus 0.1 % Ointment Encube","","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Dent Paste G&W","","","Select","Select",""],["","","VALACYCLOVIR","1 GM","","Select","Select",""],["","","Ramelteon","8 MG","","Select","Select",""],["","","DULOXETINE","30 MG","","Select","Select",""],["","","CEFPODOXIME","200 MG","","Select","Select",""],["","","ZOLPIDEM","5 MG","","Select","Select",""],["","","Fluocinonide 0.05 % Top Sol Sun Pharma","","","Select","Select",""],["","","CYCLOBENZAPRINE","10 MG","","Select","Select",""],["","","MELOXICAM","15 MG","","Select","Select",""],["","","Ketoconazole 2 % Cream Fougera","","","Select","Select",""],["","","HYDRALAZINE","50 MG","","Select","Select",""],["","","Tobramycin\/Dex 0.3\/0.1 % Ophth Susp Padagi","","","Select","Select",""],["","","Metformin","500 MG","","Select","Select",""],["","","Mirtazapine","15 MG","","Select","Select",""],["","","Erythromycin 0.5 % Ophth Oint B&L","","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Ascend Labs","","","Select","Select",""],["","","Ketoconazole 2 % Shampoo Ani Pharm","","","Select","Select",""],["","","LEVOFLOXACIN","750 MG","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","AMITRIPTYLINE","25 MG","","Select","Select",""],["","","Tacrolimus 0.1 % Ointment Fougera","","","Select","Select",""],["","","Ketoconazole 2 % Shampoo Padagis","","","Select","Select",""],["","","FAMOTIDINE","20 MG","","Select","Select",""],["","","FLUOCINONIDE","0.0005","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.001","","Select","Select",""],["","","TOBRAMYCIN\/DEX","0.3\/0.1 %","","Select","Select",""],["","","KETOCONAZOLE","0.02","","Select","Select",""],["","","TACROLIMUS","0.001","","Select","Select",""],["","","ERYTHROMYCIN","0.005","","Select","Select",""],["","","POLYMYX\/TRIMETHOPRIM","","","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":""}]}]}