{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Antone M Alves","gend":0,"currentgend":"","add":"53 GLENRIDGE DR","city":"PORTLAND","state":"ME","zip":"04102","dob":"1958-02-19","age":"","mstatus":"","insh":"10000108377","cliId":"","pno":"2072391164","cno":"","email":"antonea0219@gmail.com","ename":"","eno":"","pphy":"HASKELL, ERIC S","ppno":"2077672174","pcpadd":"301C US ROUTE 1,","pcpcity":"SCARBOROUGH","pcpstate":"ME","pcpzip":"40749701","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"53 GLENRIDGE DR","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04102","pcpfaxno":"2073968632","pcpnpi":"1770742439","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1GN9F96RF43","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R1084","R0602","R251","R140","E871","E878","G4733","Z789","Z114","Z1159","R7401","Z125","K760","F439","I10","N400","G4739","F1090","N323","K5900","G4737","R0683","R7989","F1120","Z0130","F1020","Z0101","Z23","M79644","M25521","M25511","F4321","M1812","M65312","M65311","M7711","M180","M1811","M79641","D492","L308","L570","L821","D485","R6889","Z136","Z0000","Z1211","K219","G4730","C44722","L98491","Z538","E785","F419","M7702","H903","S61011A","Z87891","Z6825","Z9682","I700","F331","R221","N529","R6882"],"date":["2023-07-10","2023-07-10","2023-07-10","2023-08-27","2023-07-24","2023-07-10","2024-05-28","2024-04-09","2023-08-03","2023-08-03","2023-08-03","2023-08-03","2023-08-14","2023-08-25","2024-02-29","2023-08-27","2023-08-25","2023-09-05","2023-08-27","2023-08-27","2023-08-28","2023-08-28","2023-09-06","2023-09-05","2023-10-10","2023-09-05","2023-09-29","2024-02-29","2023-11-01","2023-12-27","2023-11-01","2024-06-05","2024-07-09","2024-05-23","2023-11-30","2024-07-09","2023-11-07","2023-11-07","2023-12-27","2023-11-03","2023-11-03","2023-11-03","2023-11-03","2023-11-03","2023-09-29","2024-05-28","2023-12-04","2024-01-09","2024-01-09","2024-01-09","2024-01-10","2024-01-12","2024-01-08","2024-02-07","2024-02-07","2024-02-08","2024-02-15","2024-02-29","2024-02-29","2024-03-06","2024-04-09","2024-03-20","2024-06-12","2024-04-21","2024-05-28","2024-05-28"],"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",""],["","","Tramadol","50 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Betamethasone Diprop Aug 0.05 % Ointment L","","","Select","Select",""],["","","Dicyclomine","10 MG","","Select","Select",""],["","","Lisinopril\/Hydrochlorothiazide","20\/25 MG","","Select","Select",""],["","","Sertraline","100 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Pravastatin","40 MG","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Rosuvastatin","10 MG","","Select","Select",""],["","","Nexlizet","","","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":""}]}]}