{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert F Jardine","gend":0,"currentgend":"","add":"347 JOHNSON MILL RD","city":"Orrington","state":"ME","zip":"04474","dob":"1947-06-16","age":"","mstatus":"","insh":"10000018535","cliId":"","pno":2078253460,"cno":"","email":"","ename":"","eno":"","pphy":"PROKOP, DAVID","ppno":2079073300,"pcpadd":"C\/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT,PO BOX 7291","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42437291","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"347 JOHNSON MILL RD","madd2":"","madd3":"","mcity":"Orrington","mstate":"ME","mzip":"04474","pcpfaxno":2079071923,"pcpnpi":1922028919,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3MR5Y61YT86","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","E119","I480","R0602","J069","Z20822","Z87891","I340","I5020","Z95810","I2510","E1142","D6869","I110","M170","I10","Z4502","I25110","I083","I4819","Z7901","I509","I4891","I252","I081","I209","L570","E782","Z23","I77810","I447","I517","I4729","R0781","W19XXXA","R059","I5022","R079","R0600","I25119"],"date":["2025-03-13","2025-10-28","2024-08-10","2023-04-02","2023-04-02","2023-04-02","2023-04-02","2024-05-01","2024-05-08","2023-12-21","2023-12-21","2024-11-14","2024-11-14","2024-11-14","2024-11-14","2025-01-18","2025-09-24","2023-12-22","2024-04-08","2024-06-24","2024-06-24","2024-06-08","2023-04-10","2023-04-10","2023-12-05","2024-04-10","2025-03-13","2023-02-17","2025-10-28","2024-04-08","2024-04-10","2024-04-10","2023-01-27","2025-02-04","2025-02-04","2024-04-07","2023-10-05","2024-04-07","2024-04-07","2022-09-28"],"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":[["","","CARVEDILOL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","BUMETANIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","GLIPIZIDE","","","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":""}]}]}