{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert B Sloma","gend":0,"currentgend":"","add":"15 MCKENNA DR","city":"RANDOLPH","state":"ME","zip":"04346","dob":"1934-03-21","age":"","mstatus":"","insh":"10000090883","cliId":"","pno":"","cno":2074417448,"email":"declined@03182025.com","ename":"","eno":"","pphy":"GREENLEAF, REBECCA","ppno":2077952800,"pcpadd":"76 HIGH ST FL 1,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407649","pcpcounty":"","pcpid":"","pcpname":"TOPSHAM FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"15 MCKENNA DR","madd2":"","madd3":"","mcity":"RANDOLPH","mstate":"ME","mzip":"04346","pcpfaxno":2077952808,"pcpnpi":1164782819,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7M28CD5AU36","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C9000","H25813","J209","H6122","Z87891","U071","K8020","N200","I2510","K7689","C679","L570","L821","L814","Z08","Z86006","R21","R600","D472","X32XXXA","L820","L298","H9201","H25811","Z1211","D122","R932","J40","D649","H6090","H6092","R933","R5383","Z79899","Z8551","D72819","H938X2","K635","R059","U099","Z0100","R112","R531","R509","H52223","H524","Z136","K521","T451X5A","Z4802","S91312D","X58XXXD","C672","Q999","R6889","D61818","D539","D72810","S91312A","H00025","Z139","K8010","K8012","H25812","Z1159","Z20822","J9811","K829","N529","N390","R739","K828","R1010","R1084","R110","D123","L989","D0339","D0462"],"date":["2025-10-27","2024-02-08","2025-01-09","2024-05-03","2024-04-23","2023-12-20","2023-08-22","2023-08-10","2023-08-10","2023-08-10","2025-07-07","2025-04-29","2024-10-09","2024-10-09","2024-10-09","2024-10-09","2025-04-29","2025-04-29","2025-10-27","2023-02-14","2023-02-14","2023-02-14","2024-09-27","2024-02-08","2024-10-30","2024-10-30","2024-07-16","2025-01-16","2024-07-03","2024-06-14","2024-05-10","2024-10-30","2024-06-13","2025-09-30","2024-06-20","2024-07-03","2024-04-25","2024-10-30","2024-11-13","2023-05-16","2025-01-30","2024-01-05","2024-01-05","2024-01-05","2025-01-30","2024-01-26","2024-01-29","2025-09-30","2025-09-30","2023-06-23","2023-06-23","2023-06-23","2024-07-16","2024-07-03","2023-06-14","2024-07-03","2024-07-03","2024-07-03","2023-06-14","2024-09-30","2024-07-03","2023-09-01","2023-09-01","2024-02-22","2024-07-29","2024-01-05","2024-01-05","2023-08-21","2023-08-21","2024-01-05","2024-03-20","2023-08-22","2023-08-10","2023-08-10","2023-08-10","2024-10-30","2022-10-14","2022-10-14","2022-09-02"],"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":[["","","PAXLOVID (EUA)","","","Select","Select",""],["","","NOVAVAX COVID 2024-2025 (EUA)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}