{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Richard D Robertson","gend":0,"currentgend":"","add":"11 NELLIGAN DR","city":"Holden","state":"ME","zip":"04429","dob":"1948-11-20","age":"","mstatus":"","insh":"10000027812","cliId":"","pno":"","cno":2079494715,"email":"Rick112048@gmail.com","ename":"","eno":"","pphy":"MAMULA, MEGHAN R","ppno":2079891567,"pcpadd":"Brewer Medical Center,735 Wilson St","pcpcity":"Brewer","pcpstate":"ME","pcpzip":"04412","pcpcounty":"","pcpid":"","pcpname":"BREWER MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"11 NELLIGAN DR","madd2":"","madd3":"","mcity":"Holden","mstate":"ME","mzip":"04429","pcpfaxno":2079470435,"pcpnpi":1457456733,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1GM9H45QF42","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R351","I10","R030","Z79899","Z7982","R6889","L858","Z0100","Z0000","D72819","E781","I2510","L300","L570","D485","D225","L821","L814","L2089","Z0101","H524","H43812","H2513","Z953","I081","I2720","Z952","Z951","I350","I371","I340","E785","I119","E663","C44622","L989","N400","N401","N529","E7800","I110","I5030"],"date":["2023-04-26","2025-09-02","2023-04-26","2023-04-26","2023-04-26","2023-04-28","2025-05-20","2024-07-31","2025-05-30","2023-05-11","2024-05-21","2024-09-18","2024-07-29","2025-05-20","2025-05-20","2025-05-20","2025-05-20","2025-05-20","2025-05-20","2025-08-04","2025-08-04","2025-08-04","2025-08-04","2023-07-13","2024-09-06","2024-09-06","2024-09-06","2024-09-06","2023-09-11","2023-07-13","2023-07-13","2024-09-18","2024-09-18","2024-09-18","2025-06-10","2025-05-06","2022-10-11","2022-07-20","2022-07-20","2022-07-12","2022-06-17","2022-06-17"],"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":[]},{"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":""}]}]}