{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Henry P Mobley","gend":0,"currentgend":"","add":"25 SHORE FARM LN","city":"Kennebunkport","state":"ME","zip":"04046","dob":"1944-03-20","age":"","mstatus":"","insh":"10000091282","cliId":"","pno":"2072510086","cno":"","email":"hmobley3@gmail.com","ename":"","eno":"","pphy":"CATHCART, SCOTT","ppno":"2077745816","pcpadd":"Intermed,84 Marginal Way Ste 700","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04101","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"25 SHORE FARM LN","madd2":"","madd3":"","mcity":"Kennebunkport","mstate":"ME","mzip":"04046","pcpfaxno":"","pcpnpi":"1659876571","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8VT1WF8WD25","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0101","H16223","H25012","H35341","H5202","H5211","H524","G4733","L219","L821","Z85828","L570","E6601","R7303","I10","E8881","H35371","H43822","H35051","Z713","M1711","Z6841","R6889","M25561","G8929","M25571","E7800","Z0001","R918","E6609","L03039","L600","L820","Z1211","K635","E785","D044","N289","R000","Z0000","D492","D120","Z860101","K5730","Z0189","E66812","Z23","H35342","N1831","E8352","H6123","R053","H52223","J208","H59811","H25812","R7989","E66813","H353213","Z961","H2512"],"date":["2025-05-20","2023-05-04","2023-05-04","2023-05-04","2023-05-04","2023-05-04","2024-05-14","2026-02-14","2023-06-19","2025-06-16","2023-06-19","2025-06-16","2026-02-03","2025-12-05","2025-04-07","2023-09-01","2024-10-02","2024-10-02","2024-10-02","2023-11-07","2026-02-10","2025-09-24","2023-11-13","2023-12-22","2023-12-22","2023-11-07","2025-12-05","2024-11-21","2024-12-09","2024-03-06","2023-12-18","2024-02-12","2024-11-21","2025-07-09","2024-06-05","2024-06-26","2025-06-16","2024-12-18","2025-07-02","2025-12-03","2025-06-16","2025-07-09","2025-07-09","2025-07-09","2025-11-12","2025-12-03","2025-09-16","2024-10-02","2026-03-04","2025-12-16","2025-12-03","2025-01-28","2025-05-20","2024-12-09","2025-09-30","2025-09-30","2025-03-12","2025-04-09","2025-09-30","2025-04-02","2025-04-02"],"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":[["","","GAVILYTE-G","","","Select","Select",""],["","","Bd Nano 2 Gen","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","12.5 MG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","Chlorhexidine 0.12 % Oral Rinse Rising","","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","ATORVASTATIN","40 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","CEFDINIR","300 MG","","Select","Select",""],["","","LISINOPRIL","40 MG","","Select","Select",""],["","","TERAZOSIN","5 MG","","Select","Select",""],["","","Fluzone High-Dose Quad 2023-24","","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","CHLORHEXIDINE","0.0012","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD","","","Select","Select",""],["","","FLUAD QUAD","","","Select","Select",""],["","","BD NANO","","","Select","Select",""],["","","COMIRNATY","","","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":""}]}]}