{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert B Barca","gend":0,"currentgend":"","add":"70 FESSENDEN ST","city":"PORTLAND","state":"ME","zip":"04103","dob":"1950-10-07","age":"","mstatus":"","insh":"10000096204","cliId":"","pno":2073185172,"cno":"","email":"blue75superbeetle@gmail.com","ename":"","eno":"","pphy":"WINTERS, TESS","ppno":2078741489,"pcpadd":"InterMed,100 Foden Rd Ste 203","pcpcity":"South Portland","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"70 FESSENDEN ST","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":2075238590,"pcpnpi":1104385962,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9D24F81WD73","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25511","M75101","G8929","M5450","M2560","M6281","M62838","M546","Z23","M47814","M4722","M2578","M47817","M47816","L570","L814","D225","L821","M9902","M9904","M9903","M9905","M9906","S92534A","Z0000","R0609","M9900","M9901","M9908","M542","Z0100","R6889","D649","L578","T148XXA","S92919A","K4090","K4020","I10","Z125","M180","H903","N182","M1811","M79645","M79644","Z13220","Z131","M47812","B078","M5417","R5383","Z03818","M1711","M5134","L820"],"date":["2023-12-27","2023-11-07","2025-08-13","2025-08-13","2024-05-03","2024-05-03","2024-05-03","2024-05-03","2025-09-15","2023-01-04","2023-10-26","2023-10-26","2023-11-08","2025-08-13","2024-11-20","2024-11-20","2024-11-20","2023-11-10","2023-11-14","2023-11-14","2023-11-14","2023-11-14","2023-08-24","2025-05-20","2025-03-05","2025-10-03","2023-07-13","2023-07-13","2023-07-13","2023-10-05","2025-02-03","2023-12-08","2024-05-17","2024-11-20","2025-05-20","2025-05-20","2024-05-17","2024-07-15","2025-03-20","2025-03-20","2025-09-16","2024-01-18","2025-10-15","2025-10-15","2025-09-16","2025-09-16","2023-02-09","2023-02-09","2023-10-09","2022-11-03","2022-09-23","2022-08-05","2022-08-04","2022-06-13","2022-05-29","2022-05-26"],"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":[["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","AMOXICILLIN","","","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":""}]}]}