{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Roberta A Gurney","gend":1,"currentgend":"","add":"87 LEWISTON RD","city":"GRAY","state":"ME","zip":"04039","dob":"1954-06-08","age":"","mstatus":"","insh":"10000062326","cliId":"","pno":2078378887,"cno":"","email":"bobbi.gurney@yahoo.com","ename":"","eno":"","pphy":"LOISELLE, DANIEL","ppno":2077745816,"pcpadd":"100 FODEN ROAD WEST,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 233","madd2":"","madd3":"","mcity":"GRAY","mstate":"ME","mzip":"04039","pcpfaxno":2078741483,"pcpnpi":1316906589,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8NM4CA3UU63","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z981","M47816","M4316","M48061","M810","R21","M25512","E669","Z0000","E7800","E039","E668","E041","M19072","Z96611","E042","Z1231","Z96612","E66811","M25519","M48062","Z0001","A000","E88819","E8881","Z0101","Z4789","M79672","M25572","R6889","Z5181","D122","Z86010","D123","D124","K5900","R000","M25552","Z23","H04123","Z1159","D120","K589","M160","M4306","M5416","E890","N610","G8918","M19012","E785","M75102","R69","Z01818","M75112","M25412","M25511","Z6833","Z01812","M19011","M19019","M75111","M24111","M5450","M159","F411","G8929","M8588"],"date":["2025-09-09","2025-09-09","2025-09-09","2025-05-29","2025-11-13","2023-11-09","2022-12-30","2023-09-22","2024-09-16","2025-09-17","2025-09-17","2024-07-02","2025-09-17","2024-09-20","2023-03-23","2023-11-14","2024-12-30","2024-12-17","2025-07-15","2024-07-02","2025-09-09","2025-09-24","2025-07-31","2025-07-15","2023-08-22","2024-04-15","2025-07-31","2024-09-20","2024-09-20","2023-12-08","2025-07-15","2023-03-31","2023-03-31","2023-03-31","2023-03-31","2023-02-14","2023-02-14","2025-06-03","2023-12-29","2025-04-22","2024-09-09","2023-03-31","2023-03-31","2025-05-29","2025-07-28","2025-07-28","2025-07-28","2024-04-10","2022-11-04","2022-11-04","2022-11-04","2022-11-04","2022-11-11","2022-10-18","2022-07-07","2022-07-07","2022-06-13","2022-04-20","2022-03-29","2022-04-01","2022-03-22","2022-03-09","2022-03-09","2022-03-09","2022-03-04","2022-03-04","2021-12-01","2021-12-21"],"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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","SCOPOLAMINE","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","FUROSEMIDE","","","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":""}]}]}