{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert F Durgin","gend":0,"currentgend":"","add":"31 ELIOT RD","city":"KITTERY","state":"ME","zip":"03904","dob":"1956-06-13","age":"","mstatus":"","insh":"10000086520","cliId":"","pno":2074398300,"cno":"","email":"skate2345@comcast.net","ename":"","eno":"","pphy":"LUTZ, STEPHEN","ppno":8002225154,"pcpadd":"Martins Point Health Care,161 Corporate Dr","pcpcity":"Portsmouth","pcpstate":"NH","pcpzip":"03801","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"31 ELIOT RD","madd2":"","madd3":"","mcity":"KITTERY","mstate":"ME","mzip":"03904","pcpfaxno":6034305033,"pcpnpi":1881640761,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5K14E92KF93","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I2510","M5126","M48061","M5416","M47816","I10","I255","E785","R6889","Z23","R809","L570","M5450","E109","Z0101","H40013","R9720","D649","I7121","E119","R9439","M4726","M549","R262","R079","Z125","I25810","M5410","M5116","M5117","M4727","M47817","M2578","M179","M1711","M5459","D1039","Z951","K122","I700","I517","R55","R42","Z96612","R001"],"date":["2025-08-20","2025-06-30","2025-06-16","2025-06-16","2025-06-30","2025-11-13","2024-07-31","2025-07-18","2023-09-06","2025-03-19","2024-05-06","2023-09-06","2025-06-15","2025-11-13","2025-09-26","2025-09-26","2025-03-12","2025-03-12","2025-11-05","2025-07-18","2022-12-21","2025-06-16","2025-06-16","2025-06-16","2022-12-21","2024-10-22","2024-06-03","2024-08-17","2024-08-28","2024-08-22","2024-08-22","2024-08-06","2024-08-06","2025-04-03","2025-04-03","2024-08-13","2024-07-15","2022-12-21","2024-07-15","2022-10-16","2022-10-16","2022-08-17","2022-07-27","2022-07-27","2022-06-11"],"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","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","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":""}]}]}