{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Eugene Robitaille","gend":0,"currentgend":"","add":"8 LAURIER ST","city":"BIDDEFORD","state":"ME","zip":"04005","dob":"1950-03-15","age":"","mstatus":"","insh":"10000113573","cliId":"","pno":"2077103233","cno":"","email":"ROBITAILLEEUGENE@GMAIL.COM","ename":"","eno":"","pphy":"HANDANOS, NICHOLAS G","ppno":"2072823349","pcpadd":"46 BARRA RD STE 201202,","pcpcity":"BIDDEFORD","pcpstate":"ME","pcpzip":"40059459","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"8 LAURIER ST","madd2":"","madd3":"","mcity":"BIDDEFORD","mstate":"ME","mzip":"04005","pcpfaxno":"2072826099","pcpnpi":"1619914025","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8KR2DT8AF16","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H02831","H02834","H57813","H02102","H02835","H02832","H02105","L570","B079","R413","G4733","E7800","Z0000","M25561"],"date":["2024-04-08","2024-04-08","2024-04-08","2024-04-08","2024-04-08","2024-04-08","2024-04-08","2024-04-03","2024-04-03","2024-05-07","2024-05-07","2024-06-05","2024-06-12","2024-07-11"],"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":[["","","Oxybutynin","5 MG","","Select","Select",""],["","","Moxifloxacin 0.5 % Ophth Sol Lupin","","","Select","Select",""],["","","Triamcinolone Acet 0.025 % Cream Macleods","","","Select","Select",""],["","","Pimecrolimus 1 % Cream Glenmark","","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Tramadol","50 MG","","Select","Select",""],["","","Citalopram","20 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":""}]}]}