{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ralph W Robbins","gend":0,"currentgend":"","add":"858 BANGOR RD","city":"ELLSWORTH","state":"ME","zip":"04605","dob":"1947-06-18","age":"","mstatus":"","insh":"10000023704","cliId":"","pno":2078011303,"cno":2078011303,"email":"declined@01162019.com","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":"858 BANGOR RD","madd2":"","madd3":"","mcity":"ELLSWORTH","mstate":"ME","mzip":"04605","pcpfaxno":2073380332,"pcpnpi":1538150503,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9TW4NC7RD98","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","I4891","I083","I442","I495","Z01810","M549","Z5181","H43811","Z0101","M1612","J449","Z9181","E6601","M169","M47816","I350","I340","I071","R0600","M461","T84032A","I110","I080","Z96651","Z471","Z96653","M25461","I10","I2510","M25561","Z7901","Z8614","M7918","M5416","Z79899","I4819","Z006","I5032","H524","I2720","Z9189","M5450","M542","Z0000","M25571","I119","N2889","T8453XD","Z8619","Z792","F32A","M51360","R0602","M8008XA","M47812","M160","T8453XS","G8929","M4856XA","M5030","D5910","I480","M25569","J8410","M1711","H43812","T84012A","Z01818","Z96659","Z5189","Z952","I509","B952","B9561","R918","M48061","T8484XA","Z48812","Z953","M6788","M7061","M7062","I517","M4807","M5117","M4727","Z96652","T8453XA","Z6842"],"date":["2025-09-05","2025-04-17","2023-01-04","2023-08-30","2023-01-04","2025-05-23","2024-05-09","2024-02-20","2023-11-17","2024-11-26","2023-03-20","2024-03-04","2024-03-23","2024-03-23","2024-03-23","2025-04-22","2025-06-09","2024-11-08","2023-02-07","2022-12-15","2025-06-09","2024-10-10","2025-06-27","2025-04-17","2024-10-10","2025-08-05","2025-08-05","2025-08-05","2025-06-10","2025-02-13","2025-08-05","2025-04-17","2025-04-17","2025-04-10","2025-03-13","2023-12-14","2025-05-29","2025-05-29","2025-06-27","2024-11-26","2023-08-30","2023-03-01","2024-05-09","2024-03-20","2025-05-13","2024-02-10","2024-02-10","2025-06-16","2024-05-13","2024-05-13","2024-05-13","2024-05-28","2025-04-22","2025-03-12","2025-05-06","2023-10-17","2022-12-14","2023-10-03","2022-11-10","2025-04-24","2023-10-17","2023-08-30","2025-07-02","2025-03-03","2022-12-28","2025-03-03","2024-10-22","2025-03-03","2025-03-03","2025-03-03","2023-05-23","2025-06-18","2024-11-20","2023-05-23","2023-05-23","2024-02-20","2025-04-27","2025-03-03","2025-06-27","2025-06-27","2023-07-20","2023-09-06","2023-09-06","2025-02-24","2022-09-10","2022-09-10","2022-09-10","2022-09-30","2022-09-30","2022-09-30"],"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":[["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","ABRYSVO","","","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":""}]}]}