{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Richard F Dupont","gend":0,"currentgend":"","add":"125 HUSTON RD","city":"GORHAM","state":"ME","zip":"04038","dob":"1945-11-02","age":"","mstatus":"","insh":"10000107639","cliId":"","pno":"9416628484","cno":"","email":"rfdupont1@gmail.com","ename":"","eno":"","pphy":"ACHILLE, JUSTINE","ppno":"","pcpadd":"Martins Point Health Care,PO Box 9746","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04104","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"125 HUSTON RD","madd2":"","madd3":"","mcity":"GORHAM","mstate":"ME","mzip":"04038","pcpfaxno":"","pcpnpi":"1962962324","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6VC3G12TR92","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G3185","M4802","M13831","N401","M25531","M25641","Z13220","Z23","Z0000","M25611","Z0101","R6889","G241","Z515","Z7189","M6281","R2681","G238","R279","I609","Z01812","I7140","R278","R634","R1312","E871","S32000A","R55","S42031A","R4701","R41841","R079","S2241XA","Z743","R6330","S42031D","Z01818","R471","G3184","I6930","S0990XA","I6200","S2241XD","I7143","R911","S3991XA","S3993XA","R918","R7301","S066XAA","M51370","M47816","S32050A","W1839XA","I080","I499","M5450","S066X0A","S199XXA","Z5181","J984","R0602","S3992XA","S42001A","Z981","R531","S51011A","S32048D","S32058D","G9340","W19XXXA","S065X0A","R0902"],"date":["2026-03-10","2023-08-17","2023-08-17","2025-07-09","2023-08-28","2023-08-28","2023-09-22","2024-10-14","2023-10-02","2025-07-01","2024-12-03","2023-12-15","2024-03-22","2024-04-29","2024-04-29","2026-03-09","2026-03-09","2026-03-09","2026-02-27","2026-03-10","2025-05-01","2025-12-31","2026-01-30","2025-02-27","2026-03-05","2025-10-20","2025-09-15","2025-09-26","2025-09-10","2026-03-05","2026-03-05","2025-09-11","2025-08-22","2025-08-22","2025-09-10","2025-09-25","2025-05-06","2025-12-02","2026-01-16","2026-01-16","2025-08-15","2025-11-25","2025-09-01","2025-12-31","2025-02-27","2025-08-15","2025-08-15","2025-08-19","2024-10-02","2025-08-15","2025-05-22","2025-05-22","2025-08-14","2025-08-15","2025-08-18","2025-08-18","2025-05-22","2025-08-15","2025-08-15","2025-06-23","2025-08-15","2025-08-15","2025-08-14","2025-08-15","2025-08-14","2025-08-15","2025-08-17","2025-08-14","2025-08-14","2025-08-21","2025-08-22","2025-08-15","2025-08-15"],"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":[["","","PREDNISONE","20 MG","","Select","Select",""],["","","TAMSULOSIN","0.4 MG","","Select","Select",""],["","","METOPROLOL SUCC","100 MG","","Select","Select",""],["","","Clobetasol 0.05 % Cream Encube","","","Select","Select",""],["","","MELOXICAM","7.5 MG","","Select","Select",""],["","","CLOBETASOL","0.0005","","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":""}]}]}