{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert L King","gend":0,"currentgend":"","add":"138 E COMMONWEALTH DR","city":"PORTLAND","state":"ME","zip":"04103","dob":"1948-12-20","age":"","mstatus":"","insh":"10000083267","cliId":"","pno":2077976498,"cno":8574259845,"email":"robertleeking@gmail.com","ename":"","eno":"","pphy":"POULIN, SAMUEL J","ppno":2078282402,"pcpadd":"Martins Point Health Care,331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"138 E COMMONWEALTH DR","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":2078282433,"pcpnpi":1841827003,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3M68HY1WM24","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":["D649","C8298","R000","G4733","I4892","Z7982","R339","I2510","I7121","E7800","G620","R300","D044","C4442","C8258","I491","M898X9","R0902","R319","C44321","D492","J449","C44329","J441","D0439","L570","Z85828","J432","J479","E538","Z1211","D122","Z860101","Z8572","J8410","R918","C44229","F419","I083","I77810","I080","I77819","I499","R0602","C8290","C44629","L578","C44319","R310","Z0000","I509","D61818","L98499","Z9049","K469","Z87891","Z510","N281","N401","N3289","N3000","R399","L821","Z955","D023","R109","L600","R0989","Z08","Z923","J439","F1021","R1013","N400","Z8616","R234","Z8042","R5383","I5189","R351","Z0389","R7989","I483","D7589","Q828","R634","J849","R079","D0422","D485","N5314","J438","L905","N200","R059","Z760","Z20822","R6889","H903","C44529","H9193","Z599","I714"],"date":["2025-09-04","2025-04-10","2023-03-30","2025-01-15","2023-06-13","2023-03-30","2025-11-04","2024-06-06","2024-02-29","2024-06-06","2025-03-04","2025-02-11","2025-07-09","2025-07-09","2025-04-21","2023-06-13","2025-06-18","2024-01-23","2024-03-20","2025-04-11","2025-03-06","2025-11-11","2024-12-02","2025-10-17","2025-07-09","2025-09-10","2025-09-10","2025-10-17","2025-10-17","2023-12-27","2025-06-16","2025-06-16","2025-06-16","2025-09-04","2025-10-17","2025-10-17","2023-12-22","2025-06-16","2023-04-20","2023-04-20","2024-02-28","2024-02-28","2024-02-28","2024-03-18","2025-01-09","2023-12-06","2025-09-10","2025-04-11","2024-07-22","2024-06-06","2024-02-15","2025-01-09","2025-05-09","2025-02-20","2025-02-20","2025-02-20","2024-06-21","2024-07-22","2025-11-04","2024-04-19","2023-10-13","2023-07-28","2025-09-10","2024-08-01","2023-07-21","2024-02-22","2023-08-30","2024-05-21","2024-08-29","2024-08-29","2025-01-09","2023-02-13","2023-10-18","2023-10-18","2023-01-19","2025-04-18","2024-03-20","2023-09-26","2024-03-18","2025-11-04","2024-04-15","2024-02-29","2024-03-22","2025-01-09","2023-07-25","2024-09-17","2023-03-29","2023-03-29","2023-07-25","2023-07-25","2023-09-21","2024-05-29","2025-03-06","2024-02-29","2024-05-21","2023-03-29","2022-12-21","2022-12-21","2022-09-21","2022-09-29","2022-08-26","2022-08-26","2022-08-09"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","BETAMETHASONE DIPROPIONATE","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SILVER SULFADIAZINE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","CYCLOSPORINE","","","Select","Select",""],["","","SSD","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","DILTIAZEM 24HR ER","","","Select","Select",""],["","","MIDODRINE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","DILTIAZEM HCL","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":""}]}]}