{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sandra L Carslick","gend":1,"currentgend":"","add":"128 COOMBS RD","city":"BRUNSWICK","state":"ME","zip":"04011","dob":"1957-04-26","age":"","mstatus":"","insh":"10000112637","cliId":"","pno":2077512079,"cno":"","email":"scarslick@gmail.com","ename":"","eno":"","pphy":"EYERER, GEORGE","ppno":"","pcpadd":"Martins Point Health Care,114 Bath Rd","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"128 COOMBS RD","madd2":"","madd3":"","mcity":"BRUNSWICK","mstate":"ME","mzip":"04011","pcpfaxno":"","pcpnpi":1841827169,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7QK1MK8JP08","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","F339","S0990XA","M9901","M9902","M9903","M9904","M546","M5030","M5412","E559","D509","Z139","B6000","A6920","A6922","M4726","M25551","M62838","M4316","M9905","M5459","F411","H40013","M47812","Z981","R5383","M5450","R293","Z0189","M47816","M2560","R002","F32A","M542","S0003XA","Z1231","Z471","M79603","M5126","M25561","M25661","M7651","G5702","H401223","Z4789","M5116","M48061","Z0101","M4802","Z136","Z1279","H8111","M25562","R197","F4389","I83893","F419","M5416","K449","M7918","R1319","M25461","M1712","M23307","Z96651","F418","K219","E639","E349","M5414","L821","D225","L578","L570","K769","E039","G4730","G90512","D251","D252","R102","N859","M5417","H401131","D729","M66261","M8588","Z961","R531","C44519","D492","L720","L814"],"date":["2025-11-13","2025-10-22","2025-11-09","2025-11-17","2025-11-17","2025-11-10","2025-11-10","2025-11-17","2025-11-17","2024-11-06","2025-11-04","2024-11-25","2024-11-25","2025-07-14","2025-10-27","2025-07-14","2025-10-09","2025-10-09","2025-10-09","2025-10-09","2025-10-24","2025-10-24","2025-11-17","2025-05-21","2024-11-20","2024-08-13","2025-11-04","2025-11-19","2025-11-19","2025-02-12","2024-12-17","2024-11-06","2024-06-30","2024-06-29","2025-11-11","2025-11-09","2025-02-06","2024-03-07","2024-01-17","2025-08-06","2024-06-12","2024-06-12","2024-06-12","2024-12-26","2025-06-27","2025-10-16","2025-09-12","2025-07-17","2025-01-15","2024-07-30","2024-11-25","2024-05-28","2024-06-18","2025-01-27","2024-08-09","2024-09-04","2025-01-16","2025-09-04","2025-09-12","2024-12-03","2024-11-20","2024-10-24","2024-10-29","2025-01-27","2025-01-27","2025-01-27","2025-09-12","2024-12-03","2024-01-24","2024-07-15","2025-07-10","2025-05-02","2025-05-02","2025-05-02","2024-08-30","2024-12-03","2025-09-12","2024-12-03","2024-10-08","2023-05-16","2023-05-16","2023-05-16","2023-05-16","2025-05-13","2025-08-05","2025-05-09","2024-02-21","2024-04-15","2024-02-09","2024-01-17","2024-01-11","2025-05-02","2025-05-02","2025-05-02"],"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":[]},{"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":""}]}]}