{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert Bond","gend":0,"currentgend":"","add":"28 GATEKEEPER LN","city":"TRENTON","state":"ME","zip":"04605","dob":"1947-04-15","age":"","mstatus":"","insh":"10000017108","cliId":"","pno":2076675330,"cno":"","email":"","ename":"","eno":"","pphy":"WEISS, ROBERT D","ppno":2073389968,"pcpadd":"PO BOX 8,10 WAYMAN LANE","pcpcity":"BAR HARBOR","pcpstate":"ME","pcpzip":"46090008","pcpcounty":"","pcpid":"","pcpname":"COOPER GILMORE HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"28 GATEKEEPER LN","madd2":"","madd3":"","mcity":"TRENTON","mstate":"ME","mzip":"04605","pcpfaxno":2073380332,"pcpnpi":1538150503,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7MA1GD7VM80","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L570","K2100","K319","E1121","Z5181","L988","H4311","Z23","Z7901","I4891","H25012","E119","Z0000","E1142","E1140","I8500","I8510","M25512","K760","K2270","C4491","G252","R1110","R053","H6123","D485","D225","L821","L814","L718","E785","Z0100","Z0001"],"date":["2025-08-01","2024-05-06","2024-05-06","2025-08-22","2025-08-12","2024-04-24","2024-11-07","2024-11-05","2025-08-12","2025-08-12","2025-05-12","2025-07-31","2025-01-06","2025-01-07","2025-04-04","2024-06-04","2024-07-16","2024-08-16","2024-10-04","2024-04-16","2023-03-09","2025-08-07","2023-03-08","2025-07-24","2025-07-24","2025-08-01","2025-08-01","2025-08-01","2025-08-01","2025-08-01","2023-03-28","2023-03-06","2023-07-19"],"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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","METFORMIN HCL","","","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":{"indx":[],"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":""}]}]}