{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Frank S Stevens","gend":0,"currentgend":"","add":"13 SPEAR AVE","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1952-04-25","age":"","mstatus":"","insh":"10000106920","cliId":"","pno":"2077124242","cno":"","email":"fss1952@yahoo.com","ename":"","eno":"","pphy":"KAZIMIERCZAK, ADAM M","ppno":"2075351340","pcpadd":"75 GRAY RD,","pcpcity":"FALMOUTH","pcpstate":"ME","pcpzip":"41052010","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE WEST FALMOUTH","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"13 SPEAR AVE","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":"2075351358","pcpnpi":"1467459032","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4XF9U37JU47","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K55059","N201","N1330","N179","Z87891","M722","N132","Z466","E039","E785","J449","N200","J45909","R109","N401","J4540","J339","N2889","M25572","M24572","M24571","R059","R519","U071","Z0000","M25511","K4020","M25611","M6281"],"date":["2023-07-24","2023-11-06","2023-07-24","2023-07-24","2024-05-20","2024-01-24","2023-08-29","2023-08-30","2023-11-15","2023-08-30","2023-08-30","2023-08-29","2023-08-30","2023-09-07","2023-09-07","2023-09-14","2023-09-14","2023-11-06","2023-11-14","2024-01-24","2024-01-24","2023-12-31","2023-12-31","2023-12-31","2024-02-01","2024-07-10","2024-05-20","2024-07-10","2024-07-10"],"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":[["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Mnexspike","","","Select","Select",""],["","","Tamsulosin","0.4 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Breo Ellipta","","","Select","Select",""],["","","Levothyroxine","125 MCG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Nitrofurantoin Macro\/Mono","100 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Valacyclovir","1 GM","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Amoxicillin\/Clav","875\/125 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":""}]}]}