{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John M Clark","gend":0,"currentgend":"","add":"41 BRACKETT ST APT 2","city":"PORTLAND","state":"ME","zip":"04102","dob":"1957-03-17","age":"","mstatus":"","insh":"10000097081","cliId":"","pno":"2078317362","cno":"","email":"jnnybasso@twc.com","ename":"","eno":"","pphy":"FELIX, BENJAMIN R","ppno":"2076622911","pcpadd":"22 BRAMHALL ST,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41023134","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE AND PED","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"41 BRACKETT ST APT 2","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04102","pcpfaxno":"","pcpnpi":"1477864486","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1EX9NR4MY26","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J301","H903","H6501","M1A0411","I10","J4540","E7849","I6523","I7121","R079","J45909","M109","I77819","I77810","I5189","I483","L209","R001","G459","R4701","K429","I480","Z760","Z79899","R4182","Z09","I499","I4719","Z7901","K449","I491"],"date":["2023-06-07","2024-01-10","2023-06-07","2023-09-15","2024-06-21","2023-09-15","2023-11-01","2023-09-16","2023-09-16","2024-06-22","2024-06-21","2023-09-16","2023-09-16","2023-11-01","2023-10-16","2024-01-23","2024-01-17","2023-09-16","2023-11-28","2023-11-28","2024-03-29","2024-06-21","2024-01-17","2024-03-28","2024-03-29","2024-04-11","2024-06-22","2024-06-21","2024-06-21","2024-06-21","2024-06-21"],"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":[["","","Dupixent","","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Omeprazole","20 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Colchicine","0.6 MG","","Select","Select",""],["","","Cyclobenzaprine","5 MG","","Select","Select",""],["","","Wixela Inhub","","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Allopurinol","100 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Tamsulosin","0.4 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":""}]}]}