{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sharon R Robertson","gend":1,"currentgend":"","add":"70 RUTH HUNTON COURT 411","city":"Westbrook","state":"ME","zip":"04092","dob":"1945-08-10","age":"","mstatus":"","insh":"10000013104","cliId":"","pno":"2078388342","cno":"","email":"shrnrobertson63@gmail.com","ename":"","eno":"","pphy":"LOUIS, EMILY C","ppno":"","pcpadd":"Martins Point Health Care, 331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"70 RUTH HUNTON COURT 411","madd2":"","madd3":"","mcity":"Westbrook","mstate":"ME","mzip":"04092","pcpfaxno":"","pcpnpi":"1366170748","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2DQ7FG0VJ40","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":["S72001D","R002","G8918","M80051A","F419","I10","M25551","Z96641","S72001A","S93402A","M25572","S60561A","W57XXXA","I491","M8000XA","M8000XD","M47896","M2242","M8580","M810","K5900","R262","R2241","I493","R079","I480","Z471","S72002D","Z736","S93505A","R2240","R6889","Z96649","Z0101","L7211","M79604","W19XXXA","H1132","H04123","S72321A","L821","D2272","L820","Z1231","L84","M79674","M79675","Z13220","R350","D1801","L718","D7589","M80051D","Z13228","R051","J069","L603","Z961","H02889"],"date":["2024-09-19","2026-04-15","2024-06-04","2024-06-04","2024-06-04","2024-06-13","2026-05-08","2026-05-08","2026-05-08","2024-01-16","2024-01-16","2024-05-16","2024-05-16","2024-06-13","2024-06-05","2024-06-06","2024-05-16","2024-05-16","2024-06-03","2025-11-12","2024-06-13","2024-06-13","2024-06-18","2023-10-16","2023-11-06","2023-10-16","2025-09-25","2024-12-10","2024-06-13","2025-08-04","2024-06-17","2023-11-02","2025-09-25","2025-09-26","2025-01-02","2024-06-03","2024-06-03","2025-11-25","2025-11-25","2024-06-03","2026-04-14","2023-11-09","2023-11-09","2023-11-01","2025-03-31","2025-03-31","2025-03-31","2025-09-05","2025-09-16","2025-06-25","2026-04-14","2024-09-27","2024-06-14","2025-09-05","2023-09-25","2023-09-25","2023-07-05","2023-06-14","2023-06-14"],"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":[["","","Metoprolol Tart","25 MG","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","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":""}]}]}