{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert R Clark","gend":0,"currentgend":"","add":"302 FERRY RD","city":"SACO","state":"ME","zip":"04072","dob":"1943-03-31","age":"","mstatus":"","insh":"10000090018","cliId":"","pno":2076510344,"cno":"","email":"rusty331@spectrum.net","ename":"","eno":"","pphy":"ZEITLIN, JAMES","ppno":2077745816,"pcpadd":"100 FODEN ROAD WEST,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41062327","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"302 FERRY RD","madd2":"","madd3":"","mcity":"SACO","mstate":"ME","mzip":"04072","pcpfaxno":2078741483,"pcpnpi":1194794859,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3P71Y61WN26","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I2510","E785","I5020","N401","J479","J449","M19011","Z0101","H40013","T8189XA","I493","J441","R351","T8189XD","T81321D","M25511","J431","R55","L509","J9601","Z136","T8131XD","R0602","Z122","I10","Z0001","N138","N410","R338","R3914","N411","Z87891","K460","K56609","J9809","I5022","R0600","Z23","H903","R7303","M7581","I110","I509","R0609","R9439","J9621","K4130","K5730","R079","R918","K9189","K567","J432","L918","R058","Z4659","Z4682","A310","K6389","R0789","Z98890","Z09","Z8619","Z8709","R002","R059","K4190","A000","N400","N3289","N218","N323","R310","N4289","R319","R6889","R339","D125","D122","R102","Z1211","R399","R300","Z87442","N201","N200","R4182","R1013","N179","N210","I088","I871","K2980","R109","R1010","I959","R350","I9788","N132","K429","R195","N209","N281"],"date":["2025-11-05","2025-08-28","2025-09-04","2025-01-10","2025-10-15","2025-10-15","2023-11-27","2025-02-18","2025-02-18","2024-11-14","2025-09-04","2025-11-05","2025-01-10","2024-11-14","2024-11-14","2023-11-27","2025-07-30","2024-11-21","2024-11-21","2025-11-05","2025-07-16","2024-10-14","2025-11-04","2025-10-15","2025-08-28","2025-02-14","2023-05-22","2023-05-22","2023-05-22","2023-05-22","2023-05-22","2025-05-28","2024-09-07","2024-09-04","2024-02-20","2025-07-30","2025-08-20","2025-10-08","2023-07-06","2024-08-15","2023-12-11","2025-05-28","2025-11-05","2024-12-16","2024-12-16","2025-07-16","2024-08-30","2024-08-30","2024-08-31","2025-03-27","2024-09-07","2024-09-07","2024-09-02","2025-04-15","2025-03-27","2024-09-05","2024-09-05","2025-10-15","2024-09-02","2024-06-28","2024-09-25","2025-08-28","2024-03-08","2024-03-08","2025-11-04","2025-08-20","2024-09-12","2024-09-14","2022-11-03","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-11-03","2022-11-03","2022-11-20","2022-10-17","2022-09-16","2022-09-16","2022-09-20","2022-09-16","2022-08-30","2022-08-30","2022-08-30","2022-08-12","2022-07-28","2022-07-28","2022-07-05","2022-07-06","2022-07-05","2022-06-29","2022-06-29","2022-07-06","2022-07-06","2022-07-05","2022-07-04","2022-07-01","2022-07-01","2022-06-18","2022-06-18","2022-04-05","2022-04-05","2022-02-14"],"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":[["","","SPIRONOLACTONE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","CICLOPIROX","","","Select","Select",""],["","","LOVASTATIN","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","LEVALBUTEROL TARTRATE HFA","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","DUTASTERIDE","","","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":""}]}]}