{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Philip T Brehmer","gend":0,"currentgend":"","add":"91 SPRUCE POINT LANE","city":"WHITING","state":"ME","zip":"04691","dob":"1960-06-14","age":"","mstatus":"","insh":"10000105713","cliId":"","pno":"2072638846","cno":"","email":"ptbrehmer60@yahoo.com","ename":"","eno":"","pphy":"CASSIDY, JOHN","ppno":"","pcpadd":"Eastport Health Care Inc,30 Boynton St Eastport","pcpcity":"Eastport","pcpstate":"ME","pcpzip":"04631","pcpcounty":"","pcpid":"","pcpname":"EASTPORT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"91 SPRUCE POINT LANE","madd2":"","madd3":"","mcity":"WHITING","mstate":"ME","mzip":"04691","pcpfaxno":"","pcpnpi":"1891890166","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1RJ0DW3PX24","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z4789","M25572","M19072","E782","M654","M19032","S92002A","E119","E785","M069","M2550","R6889","M1712","M25462","M25562","H524","Z0101","S83232A","Z981","Z1211","I119","I10","D649","E559","M25532","H903","H9190","K429"],"date":["2024-04-01","2023-05-08","2024-04-01","2023-06-21","2023-11-16","2023-11-16","2023-06-26","2024-06-26","2024-05-14","2023-07-11","2024-03-05","2023-11-16","2024-06-17","2024-02-07","2023-11-30","2023-09-22","2023-09-22","2024-01-28","2024-04-01","2024-06-26","2024-03-05","2024-05-14","2024-05-14","2024-06-03","2023-12-05","2024-06-07","2024-06-14","2024-06-26"],"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":[["","","Omeprazole","20 MG","","Select","Select",""],["","","Lisinopril","10 MG","","Select","Select",""],["","","Dutasteride","0.5 MG","","Select","Select",""],["","","Cefadroxil","500 MG","","Select","Select",""],["","","Ezetimibe","10 MG","","Select","Select",""],["","","Atorvastatin","20 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Trulicity","","","Select","Select",""],["","","Afluria Quad 2023-24 (3Yr Up)","","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Tolterodine","4 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Hydroxyzine Hcl","","","Select","Select",""],["","","Atorvastatin Calcium","","","Select","Select",""],["","","Metformin","500 MG","","Select","Select",""],["","","Testosterone 1.62%","20.25 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":""}]}]}