{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert J Struba","gend":0,"currentgend":"","add":"34 RACE ST","city":"BELFAST","state":"ME","zip":"04915","dob":"1950-09-26","age":"","mstatus":"","insh":"10000059191","cliId":"","pno":2073787096,"cno":"","email":"robertstruba@gmail.com","ename":"","eno":"","pphy":"LANTZ, NATASHA L","ppno":2078588353,"pcpadd":"PO BOX 468,","pcpcity":"SKOWHEGAN","pcpstate":"ME","pcpzip":"49760468","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE AND WALK IN CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"34 RACE ST","madd2":"","madd3":"","mcity":"BELFAST","mstate":"ME","mzip":"04915","pcpfaxno":"","pcpnpi":1215459029,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4NP6QU9JJ76","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":["N401","E1142","L729","Z09","K200","K222","K449","M79645","K219","K2960","K2980","F1011","M79671","M79672","I10","I480","I509","E782","F4310","Z23","S6992XS","S30860A","F338","R7303","L578","M19042","F341","Z0101","H25813","H40053","H04123","H43811","Z1283","G629","Z4802","I2510","H25812","Z961","R918","Z9189","R059","D7219","Z8719","I4710","I491","I498","Z0000","Z9181","G609","D1801","I080","R931","R1310","K2970","H25811","F331","E7800","G4733","R2689","D62","S36039S","S36899D","R0602","M19071","S299XXA","S3993XA","S3991XA","A000","S36032A","E861","R42","R110","R0781","K661","R0789","J984","Z743","R221","R1012","R1084","D122","D120","K4020","E559","R3915","Z20822","U071","R590","F1021","F325","G621"],"date":["2025-02-13","2025-07-08","2025-02-20","2023-04-10","2023-04-10","2023-04-10","2023-04-10","2024-10-08","2023-01-26","2023-01-26","2023-01-26","2023-03-13","2023-03-13","2023-03-13","2025-11-19","2025-11-19","2025-11-19","2025-11-19","2025-05-07","2025-11-04","2025-05-01","2025-06-22","2025-09-30","2022-12-06","2024-02-27","2024-12-20","2024-02-20","2024-08-29","2023-08-23","2025-07-30","2023-08-23","2025-06-04","2024-02-27","2023-02-16","2025-02-27","2025-10-23","2024-08-29","2024-08-29","2023-01-04","2023-01-10","2023-01-19","2023-01-26","2023-04-10","2025-10-21","2025-10-21","2025-10-21","2023-05-04","2023-05-04","2023-05-04","2025-01-02","2025-10-24","2025-10-24","2023-01-26","2023-01-26","2023-10-11","2023-04-11","2023-06-21","2023-02-10","2022-11-10","2022-09-24","2022-09-21","2022-09-22","2022-09-21","2022-09-10","2022-09-10","2022-09-12","2022-09-12","2022-09-24","2022-09-13","2022-09-13","2022-09-09","2022-09-09","2022-09-09","2022-09-09","2022-09-09","2022-09-09","2022-09-09","2022-07-13","2022-06-20","2022-06-20","2022-06-20","2022-06-20","2022-05-11","2022-05-20","2022-06-01","2022-07-19","2022-07-19","2022-07-13","2022-04-21","2022-04-21","2022-04-21"],"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":[["","","OMEPRAZOLE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","NADOLOL","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","RISPERIDONE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","PROPRANOLOL HCL ER","","","Select","Select",""],["","","GABAPENTIN","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}