{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia H Roberts","gend":1,"currentgend":"","add":"10 SYLVIA CIR","city":"WATERBORO","state":"ME","zip":"04087","dob":"1947-03-15","age":"","mstatus":"","insh":"10000021433","cliId":"","pno":"","cno":2072864622,"email":"Trishrob29@yahoo.com","ename":"","eno":"","pphy":"GALBRAITH, KATHRYN L","ppno":"","pcpadd":"44 ELM ST,","pcpcity":"LIMERICK","pcpstate":"ME","pcpzip":"40483924","pcpcounty":"","pcpid":"","pcpname":"GALBRAITH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"10 SYLVIA CIR","madd2":"","madd3":"","mcity":"WATERBORO","mstate":"ME","mzip":"04087","pcpfaxno":2077939587,"pcpnpi":1740240290,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1KV5PQ8VH61","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":["E871","I10","R0989","L309","E119","E785","E039","Z0000","E1169","M25512","Z23","Z1231","R6889","M720","M818","Z1239","Z0101","M65342","M25542","K219","S3992XA","Z1211","E1165","R051","S299XXA","S3991XA","S3993XA","R059","M546","M65331","M65311","M8589","R0982","R030","S199XXA","S0990XA","R634","H524","H25813","H16223","M65321"],"date":["2023-10-13","2025-11-07","2023-10-25","2023-12-14","2025-10-22","2025-11-18","2025-10-30","2025-10-30","2025-10-30","2024-08-05","2025-09-27","2024-06-11","2023-06-30","2025-03-21","2025-08-01","2023-09-06","2024-11-21","2025-03-21","2024-03-21","2025-08-13","2025-05-04","2025-08-13","2025-04-28","2024-03-21","2025-05-04","2025-05-04","2025-05-04","2025-07-23","2025-05-07","2023-03-22","2023-03-22","2024-02-06","2024-03-21","2024-03-21","2025-05-04","2025-05-04","2023-10-25","2022-11-03","2022-10-11","2022-10-11","2022-07-13"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","GAVILYTE-N","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}