{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Terry Sawyer","gend":0,"currentgend":"","add":"416 CROSS RD","city":"BELFAST","state":"ME","zip":"04915","dob":"1957-01-12","age":"","mstatus":"","insh":"10000100226","cliId":"","pno":"2073384436","cno":"2073235852","email":"tsawyer57@hotmail.com","ename":"","eno":"","pphy":"KLEPACK, MARGARET","ppno":"","pcpadd":"11 CAPE JELLISON RD,","pcpcity":"STOCKTON SPRINGS","pcpstate":"ME","pcpzip":"49814349","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"416 CROSS RD","madd2":"","madd3":"","mcity":"BELFAST","mstate":"ME","mzip":"04915","pcpfaxno":"","pcpnpi":"1447719471","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2R17K40VM49","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K029","E1149","Z0000","Z23","Z0100","E1159","R6889","E119","I2510","Z043","M25511","I252","S2241XA","S2249XA","M7732","L97521","E11621","S91302A","E113312","E113391","I739","E1140","E113212","M19072","I7090","S91309D","E113492","M25531","N529","N1831","N478"],"date":["2023-06-06","2025-07-31","2026-02-05","2026-02-05","2025-10-16","2025-05-01","2023-12-12","2024-12-02","2025-12-10","2024-06-17","2024-06-17","2024-06-20","2024-06-18","2024-06-20","2025-01-16","2024-10-04","2024-10-18","2025-04-08","2026-02-16","2026-02-16","2025-01-23","2025-01-22","2025-10-16","2025-01-16","2025-01-16","2024-07-24","2024-10-08","2024-12-04","2023-03-10","2023-03-13","2023-01-26"],"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",""],["","","FLUCONAZOLE","150 MG","","Select","Select",""],["","","Rybelsus (Formulation R1)","","","Select","Select",""],["","","AMITRIPTYLINE","25 MG","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","ATORVASTATIN","80 MG","","Select","Select",""],["","","Clobetasol 0.05 % Shampoo Padagis","","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","ISOSORBIDE MONONITRATE","60 MG","","Select","Select",""],["","","CLINDAMYCIN","150 MG","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","METRONIDAZOLE","500 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","METOPROLOL SUCC","25 MG","","Select","Select",""],["","","TORSEMIDE","10 MG","","Select","Select",""],["","","LISINOPRIL","40 MG","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","GLIPIZIDE","10 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Ascend Labs","","","Select","Select",""],["","","Ketoconazole 2 % Shampoo Ani Pharm","","","Select","Select",""],["","","LEVOFLOXACIN","750 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.001","","Select","Select",""],["","","RYBELSUS (FORMULATION R","","","Select","Select",""],["","","KETOCONAZOLE","0.02","","Select","Select",""],["","","CLOBETASOL","0.0005","","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":""}]}]}