{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Albert L Scott","gend":0,"currentgend":"","add":"131 FALMOUTH RD","city":"WINDHAM","state":"ME","zip":"04062","dob":"1938-03-08","age":"","mstatus":"","insh":"10000108637","cliId":"","pno":"2076324452","cno":"","email":"declined@112524.com","ename":"","eno":"","pphy":"BERGERON POULIN, CHARLES KEVIN","ppno":"2076936106","pcpadd":"76 HIGH ST,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407649","pcpcounty":"","pcpid":"","pcpname":"NAPLES FAMILY PRACTICE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"131 FALMOUTH RD","madd2":"","madd3":"","mcity":"WINDHAM","mstate":"ME","mzip":"04062","pcpfaxno":"2076934026","pcpnpi":"1992291249","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3YJ7QU8TC76","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T148XXA","L0291","M9901","M5413","M9900","M9906","N471","M546","S20229A","L02416","Z0101","E113293","E119","N3281","R6521","R7881","N179","N3000","Z09","A4151","G9341","M353","S40861A","E43","Z515","Z66","K921","D649","I824Y3","T50905A","N401","N1830","R4189","R1011","L089","R531","I959","F0390","N390","M6281","B9620","A419","K625","J189","F418","I2510","R9431","M20012","R296","R4182","S0990XA","S199XXA","R0902","K8020","K5730","I82413","I82433","G9340","F03B0","E039","R079","N323","R918","Z4682","I499","Z452","M79642","M25842","R059","R5381","Z743","R410"],"date":["2023-10-13","2023-10-24","2024-11-25","2024-11-25","2024-11-25","2024-11-25","2024-04-01","2024-01-03","2024-01-03","2024-01-21","2024-02-22","2024-02-22","2025-12-09","2024-06-25","2025-10-30","2025-10-30","2025-11-05","2025-10-30","2025-12-18","2025-11-10","2025-12-16","2025-11-17","2025-05-19","2025-11-10","2025-11-10","2025-11-10","2025-11-07","2025-11-07","2025-11-12","2025-11-07","2025-09-23","2025-11-20","2025-10-07","2024-01-03","2023-10-05","2025-10-29","2025-10-29","2025-12-10","2025-03-13","2025-12-10","2025-12-10","2025-11-05","2025-11-10","2025-11-10","2025-11-10","2025-11-10","2025-10-30","2025-10-14","2025-03-01","2025-11-17","2025-03-02","2025-03-02","2025-03-02","2025-03-02","2025-03-02","2025-11-02","2025-11-02","2025-03-03","2025-03-03","2025-03-23","2025-10-29","2025-11-04","2025-10-29","2025-10-30","2025-10-31","2025-10-30","2025-10-14","2025-10-14","2025-12-18","2025-03-13","2025-11-17","2025-10-29"],"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":[["","","Dexcom G6 Transmitter","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","FREESTYLE LITE","","","Select","Select",""],["","","Bd Nano 2 Gen","","","Select","Select",""],["","","FLUTICASONE PROP","50 MCG","","Select","Select",""],["","","SERTRALINE","100 MG","","Select","Select",""],["","","Ketoconazole 2 % Cream Encube","","","Select","Select",""],["","","GEMTESA","","","Select","Select",""],["","","LISINOPRIL","5 MG","","Select","Select",""],["","","LEVOTHYROXINE","50 MCG","","Select","Select",""],["","","PREDNISONE","5 MG","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","Embecta Nano 2Nd Gen (Ref 320550)","","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","MIRTAZAPINE","7.5 MG","","Select","Select",""],["","","OMEPRAZOLE","40 MG","","Select","Select",""],["","","DONEPEZIL","10 MG","","Select","Select",""],["","","TAMSULOSIN","0.4 MG","","Select","Select",""],["","","HYDROXYZINE HCL","25 MG","","Select","Select",""],["","","Dexcom G6 Receiver (Ref Stk-Oe-001)","","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","GLIPIZIDE","10 MG","","Select","Select",""],["","","ONETOUCH ULTRA BLUE","","","Select","Select",""],["","","Dexcom G6 Sensor","","","Select","Select",""],["","","Ketoconazole 2 % Cream Fougera","","","Select","Select",""],["","","SIMVASTATIN","20 MG","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","Bd Ultra-Fine Nano (Ref 320122)","","","Select","Select",""],["","","Memantine","5 MG","","Select","Select",""],["","","Betamethasone Diprop Aug 0.05 % Ointment F","","","Select","Select",""],["","","BASAGLAR KWIKPEN","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUG","0.0005","","Select","Select",""],["","","DEXCOM G","6 RECEIVER","","Select","Select",""],["","","KETOCONAZOLE","0.02","","Select","Select",""],["","","BD NANO","","","Select","Select",""],["","","BD ULTRA-FINE NANO (REF","","","Select","Select",""],["","","EMBECTA NANO","2ND GEN","","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":""}]}]}