{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Peter Young","gend":0,"currentgend":"","add":"20 COYOTE CT","city":"WINDHAM","state":"ME","zip":"04062","dob":"1958-01-19","age":"","mstatus":"","insh":"10000101567","cliId":"","pno":"2077769440","cno":"","email":"Pmyoung58@gmail.com","ename":"","eno":"","pphy":"LENA, SEAN R","ppno":"2077745816","pcpadd":"InterMed,84 Marginal Way Ste 800","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":"20 COYOTE CT","madd2":"","madd3":"","mcity":"WINDHAM","mstate":"ME","mzip":"04062","pcpfaxno":"2078741483","pcpnpi":"1265895502","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5DG7FX2DT58","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M24151","Q6589","M25551","M24152","R1031","K5732","R1032","R9389","G8918","K5720","K6389","N2889","K5790","R1084","T8132XA","K5730","R109","Z09","T8131XA","F418","R4182","Z23","Z0000","Z933","M1711","M21061","Z01818","N135","N1330","Z932","N131","F339","F419","K660","K264","N179","R351","K658","Z471","K31A11","K2270","K5792","Z96651","Z98890","Z8719","K922","F17200","M5412","J9691","M21051","Z4682","K551","Z432","F1099","F32A","Z789","N189","Z96652","Z433","R042","Z939","K567","D62","K3189","Z96641","K9189","N178","F320","Z4659","R6889"],"date":["2023-08-25","2023-08-25","2023-08-25","2023-08-25","2023-12-20","2024-09-03","2024-01-25","2024-01-25","2025-01-27","2024-02-22","2023-12-20","2024-01-25","2024-06-18","2024-02-28","2024-02-28","2024-09-09","2024-03-04","2024-10-24","2024-02-28","2025-03-07","2025-03-07","2025-05-14","2025-05-14","2024-09-03","2026-02-09","2025-01-27","2025-01-22","2025-04-23","2025-01-24","2024-10-11","2024-12-12","2024-12-12","2024-12-12","2024-12-12","2025-05-19","2025-03-06","2024-11-20","2024-08-09","2025-02-12","2025-03-07","2025-05-19","2024-10-04","2025-05-21","2024-09-09","2025-03-28","2025-03-07","2025-03-07","2026-01-28","2025-03-02","2025-01-27","2025-03-03","2025-03-02","2024-10-11","2025-03-02","2025-03-06","2025-03-06","2024-10-11","2026-02-09","2024-08-09","2025-03-02","2025-03-05","2024-10-12","2025-03-02","2025-03-07","2025-02-12","2024-08-09","2025-03-03","2025-03-03","2024-08-12","2023-03-16"],"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",""],["","","Prednisone","20 MG","","Select","Select",""],["","","IBUPROFEN","600 MG","","Select","Select",""],["","","CIPROFLOXACIN","500 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","TAMSULOSIN","0.4 MG","","Select","Select",""],["","","OXYBUTYNIN","5 MG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","METRONIDAZOLE","500 MG","","Select","Select",""],["","","DICLOFENAC SOD","100 MG","","Select","Select",""],["","","SERTRALINE","100 MG","","Select","Select",""],["","","LOPERAMIDE","2 MG","","Select","Select",""],["","","LORAZEPAM","0.5 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","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":""}]}]}