{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Allen M Lavertu","gend":0,"currentgend":"","add":"474 GRANDVIEW AVE","city":"MADAWASKA","state":"ME","zip":"04756","dob":"1958-03-15","age":"","mstatus":"","insh":"10000106341","cliId":"","pno":"2073163575","cno":"","email":"onthe95@yahoo.com","ename":"","eno":"","pphy":"SIDORCZUK, SILWANA A","ppno":"2077287300","pcpadd":"194 E MAIN ST,","pcpcity":"FORT KENT","pcpstate":"ME","pcpzip":"47431428","pcpcounty":"","pcpid":"","pcpname":"ACADIA FAMILY HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"474 GRANDVIEW AVE","madd2":"","madd3":"","mcity":"MADAWASKA","mstate":"ME","mzip":"04756","pcpfaxno":"2077287838","pcpnpi":"1033327846","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3G56XX8GQ85","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z45018","M79651","I10","E785","G43809","M79652","Z0000","M5136","M25551","M25552","M1611","M1612","I441","M160","R6889","G8929","B356","M1610","R5383"],"date":["2024-06-04","2023-06-14","2024-06-06","2023-10-04","2023-06-14","2023-06-14","2023-06-14","2023-06-14","2023-06-14","2023-09-27","2023-07-12","2023-07-12","2023-07-14","2023-07-25","2023-07-12","2023-09-27","2023-09-01","2023-09-01","2024-06-12"],"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":[["","","Pravastatin","10 MG","","Select","Select",""],["","","Bupropion Hcl","150 MG","","Select","Select",""],["","","Nexletol","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Metoprolol Succ","50 MG","","Select","Select",""],["","","Diclofenac Sod 1 % Gel Cipla","","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Trazodone","50 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":""}]}]}