{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Daniel J Dutton","gend":0,"currentgend":"","add":"8 MACARTHUR AVE","city":"OLD ORCHARD BEACH","state":"ME","zip":"04064","dob":"1960-11-30","age":"","mstatus":"","insh":"10000111480","cliId":"","pno":"2075907975","cno":"","email":"dand3537@yahoo.com","ename":"","eno":"","pphy":"HUOT, BRAD R","ppno":"2078282402","pcpadd":"PO BOX 9746,MARTINS POINT HEALTHCARE","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"8 MACARTHUR AVE","madd2":"","madd3":"","mcity":"OLD ORCHARD BEACH","mstate":"ME","mzip":"04064","pcpfaxno":"2078282425","pcpnpi":"1891866372","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7U15C38HQ52","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":["E1149","L97421","E11621","E1142","E1169","D509","Z23","Z95810","H6121","I5023","H2512","I2510","I255","Z0101","H2511","B351","M79675","L602","I10","Z1211","Z860101","D124","D123","R9431","D120","K219","J449","I5022","I080","H2513","H40039","E119","I480","I358","I517","I5189","Z959","L851","M205X9"],"date":["2026-02-19","2024-12-03","2024-12-03","2025-10-23","2024-02-29","2025-02-20","2025-10-23","2025-12-11","2025-02-20","2025-10-14","2025-01-09","2025-10-14","2025-09-11","2025-09-04","2024-12-19","2026-02-19","2026-02-19","2026-02-19","2025-10-23","2025-07-25","2025-07-25","2025-07-25","2025-07-25","2024-07-30","2025-07-25","2025-07-25","2025-07-25","2024-08-27","2025-09-23","2024-11-12","2024-11-12","2024-11-12","2025-10-14","2024-10-24","2024-10-24","2024-10-24","2024-10-24","2024-12-16","2024-12-16"],"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":[["","","ENTRESTO","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","Moxifloxacin 0.5 % Ophth Sol Lupin","","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","PRAVASTATIN","40 MG","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","SACUBITRIL\/VALSARTAN","97\/103 MG","","Select","Select",""],["","","CARVEDILOL","12.5 MG","","Select","Select",""],["","","CYCLOBENZAPRINE","10 MG","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","ESZOPICLONE","3 MG","","Select","Select",""],["","","DOXEPIN HCL","","","Select","Select",""],["","","GLYBURIDE-METFORMIN HCL","","","Select","Select",""],["","","GLIPIZIDE\/METFORMIN","2.5\/500 MG","","Select","Select",""],["","","GAVILYTE-N","","","Select","Select",""],["","","DOXEPIN","25 MG","","Select","Select",""],["","","GLYBURIDE\/METFORMIN","2.5\/500 MG","","Select","Select",""],["","","MOXIFLOXACIN","0.005","","Select","Select",""],["","","PREDNISOLONE ACE","0.01","","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":""}]}]}