{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mark Eichenbaum","gend":0,"currentgend":"","add":"5 GLENWOOD AVENUE","city":"AUGUSTA","state":"ME","zip":"04330","dob":"1958-01-03","age":"","mstatus":"","insh":"10000104767","cliId":"","pno":"2074464486","cno":"","email":"mark.eichenbaum@gmail.com","ename":"","eno":"","pphy":"HALL, LAUREN","ppno":"2076267400","pcpadd":"MaineGeneral Medical Center,6 E Chestnut St","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"MAINE DARTMOUTH GERIATRIC MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5 GLENWOOD AVENUE","madd2":"","madd3":"","mcity":"AUGUSTA","mstate":"ME","mzip":"04330","pcpfaxno":"2076267401","pcpnpi":"1225444995","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5CK2KT2WG21","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","Z0001","M79671","R1032","R6889","Z136","Z87891","G4733","G4700","F39","Z1211","K5730","Z0000","E785","R32","Z5111","N401","R1900","M7989","N281","N323","N400","R338","Z79899","C9590","C9200","N289","K6040","D649","I2510","D709","K6030","R4020","Z515","R21","Z9189","R911","N2889","C44712","D0461","R7881","R059","R9720","D539","D72819","D696","R5081","S31109A","D61818","Z0389","R9431","A411","D485","Z20822","Z792","R000","R918","J90","R509","R55","C9201","K5790","N3289","D509","Z466","R310","N320","N138","A419","L98499","R0789","K610","Z7189","K6289","D703","Z8616","I429","Z01818","K449","Z452","R399","K219","I4710","Z87448","Z862","N529","R339","R319","S31501A","R519","R897","S31839A","R112","R5383","Z4800","I5032","I110","Z1152","D72821","R61","R0602","I420","K626","N3091","I352"],"date":["2025-07-30","2023-04-11","2023-04-11","2023-04-11","2023-05-22","2023-06-27","2025-09-16","2026-01-15","2025-09-19","2023-07-14","2024-01-31","2025-01-14","2025-08-20","2024-05-15","2024-05-22","2025-07-18","2025-08-28","2025-06-20","2025-06-19","2025-06-19","2025-06-19","2025-06-19","2025-07-11","2025-08-28","2025-07-03","2025-11-22","2026-01-06","2026-01-06","2025-05-01","2025-12-10","2025-09-16","2025-10-20","2025-01-04","2025-03-19","2025-02-13","2025-03-18","2026-01-06","2025-09-19","2025-11-12","2025-11-12","2025-08-14","2025-08-03","2025-04-10","2025-05-08","2024-12-18","2025-08-03","2025-03-15","2025-09-27","2025-08-03","2025-07-29","2025-03-02","2025-07-30","2025-11-12","2025-02-05","2025-08-12","2025-03-18","2025-08-03","2025-08-03","2025-07-31","2025-02-03","2026-01-06","2025-04-09","2025-04-09","2024-12-10","2025-05-30","2025-05-30","2025-05-30","2025-08-28","2025-05-02","2025-09-12","2025-11-24","2025-09-16","2025-03-19","2025-10-20","2025-05-29","2025-05-29","2025-12-10","2025-02-19","2025-05-23","2025-05-23","2025-12-10","2024-12-04","2025-07-30","2025-06-16","2025-05-15","2024-09-04","2025-04-25","2025-04-28","2025-10-20","2025-01-29","2024-12-18","2025-08-26","2025-03-19","2025-03-19","2025-05-09","2025-04-30","2025-04-30","2025-04-30","2025-05-08","2025-01-10","2026-01-15","2026-01-15","2025-09-23","2025-06-22","2025-01-10"],"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":[["","","MYRBETRIQ","","","Select","Select",""],["","","Doxycycline Monohydrate","100 MG","","Select","Select",""],["","","VALSARTAN","80 MG","","Select","Select",""],["","","CIPROFLOXACIN","500 MG","","Select","Select",""],["","","ACYCLOVIR","400 MG","","Select","Select",""],["","","TRAZODONE","100 MG","","Select","Select",""],["","","ATORVASTATIN","10 MG","","Select","Select",""],["","","FLUCONAZOLE","200 MG","","Select","Select",""],["","","PAXLOVID","300\/100 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","Dexamethasone Sod Phos 0.1 % Ophth Sol B&L","","","Select","Select",""],["","","OXYBUTYNIN","10 MG","","Select","Select",""],["","","TAMSULOSIN","0.4 MG","","Select","Select",""],["","","METOPROLOL SUCC","25 MG","","Select","Select",""],["","","PROCHLORPERAZINE","5 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","12.5 MG","","Select","Select",""],["","","METRONIDAZOLE","500 MG","","Select","Select",""],["","","MIRABEGRON","25 MG","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","FINASTERIDE","5 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","LEVOFLOXACIN","500 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","DEXAMETHASONE SOD PHOS","0.001","","Select","Select",""],["","","FLUAD QUAD","","","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":""}]}]}