{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robyn J Hogan","gend":1,"currentgend":"","add":"80 LONGFELLOW STREET APT 218","city":"WESTBROOK","state":"ME","zip":"04092","dob":"1949-06-18","age":"","mstatus":"","insh":"10000081664","cliId":"","pno":2073291322,"cno":"","email":"","ename":"","eno":"","pphy":"SAMITT, ALISON M","ppno":2077619320,"pcpadd":"301C US ROUTE 1,","pcpcity":"SCARBOROUGH","pcpstate":"ME","pcpzip":"40749701","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"80 LONGFELLOW STREET APT 218","madd2":"","madd3":"","mcity":"WESTBROOK","mstate":"ME","mzip":"04092","pcpfaxno":2073968632,"pcpnpi":1336242585,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7QV8W42FN25","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E785","J069","M25511","R5383","E559","S52532D","Z1211","S52502A","R1013","F329","S80811A","S0990XA","Z87891","Z122","F1010","L280","H9201","I739","R0602","F17210","R6889","R413","S90936A","M25562","R109","S52502D","Z23","L570","R922","F331","I10","M8000XD","F419","S52532A","L821","L84","N644","F321","W19XXXD","I700","L820","D1801","G8929","R1084","Z720","R531","Z95810","Z1231","J984","Z13820","Z780","M810","F4310","R918","R296","L814","S52592D","S52615D","F17200","M75121","M19011","S42025D","Z1239","B079","F1090","S93492A","M25512","S42036A","W108XXA","R0600","Z0000","Z0100","D122","D124","K635","H169","D123","K5730","R062","L739","L249","J4520","M75111","Z0101","D485","S0101XA","L658","M9905","M25552","M9903","M9902","M25561","S199XXA","L720","R928","R2689","M720","S52352A","S52612A","S42022A","W010XXA","B078","R079","I2510","M5442","F411","M4726","F341","D120","M8589","M25431","M67431","L853","M1811","K2100","D126","M85852","I447","R1010","M47817","M5432"],"date":["2024-01-10","2024-01-09","2025-06-11","2024-09-03","2024-09-03","2025-01-31","2025-09-23","2025-01-04","2024-04-01","2024-03-18","2023-09-19","2024-03-23","2025-09-29","2025-09-29","2025-11-13","2023-04-04","2023-11-06","2025-08-19","2024-12-13","2025-04-15","2023-10-20","2023-06-19","2024-07-08","2023-11-20","2023-01-03","2025-01-31","2025-11-13","2025-03-25","2023-06-28","2025-11-13","2025-05-09","2025-02-14","2025-07-31","2025-02-19","2025-09-30","2025-09-30","2023-08-28","2024-04-29","2023-06-05","2023-06-05","2023-04-04","2023-04-04","2025-05-09","2023-05-19","2024-03-06","2024-03-28","2024-03-28","2024-05-22","2025-10-16","2025-07-23","2025-07-23","2025-07-23","2023-07-28","2025-10-16","2024-04-01","2024-01-10","2025-01-13","2025-01-13","2025-11-13","2025-06-11","2025-06-11","2024-08-20","2023-07-19","2024-06-11","2025-07-03","2024-07-25","2024-08-01","2024-08-01","2024-08-01","2024-03-06","2023-08-08","2023-10-18","2025-09-23","2025-09-23","2025-09-23","2024-01-05","2025-09-23","2025-09-23","2024-12-06","2024-06-11","2024-06-11","2024-03-18","2025-05-16","2025-11-12","2024-01-10","2024-03-23","2024-01-12","2024-11-22","2024-11-22","2024-11-22","2024-11-22","2023-11-07","2024-03-23","2025-03-25","2023-06-28","2023-08-08","2023-08-08","2025-01-04","2025-01-04","2024-08-06","2025-01-06","2025-03-25","2022-11-14","2022-11-14","2022-10-11","2022-09-27","2022-08-09","2022-08-23","2022-05-11","2022-05-03","2022-07-05","2022-07-19","2022-06-17","2022-07-05","2022-05-11","2022-05-11","2022-05-03","2022-03-16","2022-03-16","2022-01-28","2022-02-18"],"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":[["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","VARENICLINE TARTRATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","MINOXIDIL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","TOBRAMYCIN-DEXAMETHASONE","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","CLINDAMYCIN PHOSPHATE","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","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":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}