{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"James W Burnham","gend":0,"currentgend":"","add":"332 GRAY RD","city":"Gorham","state":"ME","zip":"04038","dob":"1943-09-17","age":"","mstatus":"","insh":"10000015105","cliId":"","pno":2078926543,"cno":"","email":"SPDYOFFICESERVC@AOL.COM","ename":"","eno":"","pphy":"HA NGOC, TIN","ppno":2078392559,"pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2078926540,"add2":"","add3":"","madd1":"332 GRAY RD","madd2":"","madd3":"","mcity":"Gorham","mstate":"ME","mzip":"04038","pcpfaxno":2078287850,"pcpnpi":1073877791,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9AX9R29NH43","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":["M6281","R2689","R5381","F0390","I10","R634","R531","E785","R42","H903","G309","C4442","R410","Z9183","S0990XA","L570","M65322","F0150","E43","F0280","R1312","R1310","R490","M25512","M9900","M9901","M9902","M9903","G629","D485","Z043","W19XXXA","Y92129","S51011A","G319","G9389","R404","H02811","Z23","M60812","Z1211","R627","G3184","E7800","B351","G608","L84","S80862A","S80861A","W57XXXA","H35363","Z483","L905","M50322","F919","Z0389","Z602","Z0000","M25511","M47812","M4802","M4312","I6523","M5450","S199XXA","R000","R4182","Z743","M7661","J329","S161XXA","T17300A","U071","R296","S40862A","S30860A","M150","H9193"],"date":["2025-10-03","2025-10-03","2025-10-03","2025-10-03","2025-10-23","2024-09-05","2025-07-09","2025-07-16","2024-09-13","2024-09-13","2025-09-29","2023-08-15","2025-08-11","2025-07-09","2025-07-05","2023-10-18","2023-12-22","2025-08-01","2025-08-01","2025-08-01","2024-11-27","2025-06-12","2025-03-03","2023-02-15","2024-05-06","2024-05-06","2024-05-06","2024-05-06","2025-03-03","2023-06-15","2025-10-18","2025-10-18","2025-10-18","2025-09-28","2025-07-05","2024-05-22","2025-08-10","2024-07-12","2025-08-08","2024-02-27","2022-12-29","2024-08-27","2024-08-27","2025-10-23","2025-07-01","2025-07-01","2025-07-01","2024-04-23","2024-04-23","2024-04-23","2024-06-20","2023-10-18","2023-10-18","2024-05-06","2025-09-08","2025-09-08","2025-09-08","2025-05-16","2023-03-06","2025-08-10","2025-08-10","2025-08-10","2025-08-10","2024-06-08","2025-08-10","2025-08-10","2025-08-11","2025-08-11","2025-04-29","2025-08-10","2025-08-10","2024-11-15","2025-08-11","2025-08-11","2022-11-06","2022-11-06","2022-11-18","2022-11-18"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","VERAPAMIL ER","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","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":""}]}]}