{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert C Prewitt","gend":0,"currentgend":"","add":"5 TIDE MEADOW LN","city":"YORK","state":"ME","zip":"03909","dob":"1956-04-16","age":"","mstatus":"","insh":"10000109088","cliId":"","pno":2074510609,"cno":"","email":"clay@custombanner.com","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":"5 TIDE MEADOW LN","madd2":"","madd3":"","mcity":"YORK","mstate":"ME","mzip":"03909","pcpfaxno":6034305033,"pcpnpi":1881640761,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6UJ7XW5WD50","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R011","R7989","R160","M5441","R269","G4733","L570","C44311","L400","L821","L814","D1801","M5416","Z7189","L820","L538","L298","I10","E785","Z125","R634","R399","M5126","C4492","C44622","D1721","D485","D225","B351","M5116","M5117","M47816","M4807","H00024","D6869","Z48817","H6123","J329","Z08","Z85828","M549"],"date":["2024-09-06","2025-08-25","2025-08-21","2025-05-01","2025-05-01","2025-09-03","2025-08-26","2025-08-07","2025-08-26","2025-08-26","2025-08-26","2025-08-26","2025-01-01","2024-05-28","2024-05-28","2024-05-28","2024-05-28","2025-06-05","2025-04-24","2025-04-24","2025-08-15","2025-08-15","2024-12-29","2023-11-10","2023-11-10","2023-11-10","2023-09-28","2023-09-28","2023-09-28","2025-01-01","2024-12-29","2024-12-29","2024-12-29","2023-09-25","2024-02-07","2023-11-29","2025-01-31","2025-01-31","2025-07-16","2025-07-16","2025-01-01"],"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":[["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","HYDROCODONE-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":[]}},{"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":""}]}]}