{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Henry A Burnham","gend":0,"currentgend":"","add":"63 WOLCOTT ST","city":"Portland","state":"ME","zip":"04102","dob":"1947-04-21","age":"","mstatus":"","insh":"10000039145","cliId":"","pno":"2073328556","cno":"","email":"burnhamha@gmail.com","ename":"","eno":"","pphy":"RIDDLEBERGER, JAMES M","ppno":"2078282402","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":"63 WOLCOTT ST","madd2":"","madd3":"","mcity":"Portland","mstate":"ME","mzip":"04102","pcpfaxno":"2078282433","pcpnpi":"1114308277","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7R26MA4GJ58","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":["E8729","F10939","Z85038","N2889","F10231","I4892","F418","F1020","F32A","I2609","C641","F10239","R112","C649","D539","J181","R791","R1310","F10230","I10","D7589","R059","J849","R1110","E8720","S299XXA","S0990XA","S3992XA","S199XXA","F10929","Z86711","Z7901","F10130","F419","I4891","I517","I5189","U071","R0602","J029","F10930","R058","J9811","I2510","R0902","Z4682","Z452","J90","J984","J9601","I4819","F10931","R4182","G928","J8489","A4189","R918","R6330","R110","G9340","G9341","J189","J15211","F1290","R8290","R42","I2699","F1090","S3991XA","S3993XA","I501","R519","S0181XA","R0789","A000","K760","N200","K5730","R0600","K5900","R251","Z9049","D500","S7001XD","Z136","R627","I483","Z4659","E876","A419","S098XXA","S0081XA","S2241XS","R109","K469","S2241XA","S79921A","S2243XD","Z0489","Z08","Z85528","Z923","S0003XA","I499","F19939","Z66","Z23","R457","M5440","I480","M25561","W19XXXA","S8992XA","I3481","I77810","R053","S2241XD","Z736","N644","I82621","C7901","C801","D696","K828","K7030","F10920","K8020","E878","R531","K219","N62","L821","D1801","L814","D225","I358","R609","R58","R1111","F4321","C799","R0689","S32030D","E669","R1084","F10129","I700","T161XXA","M47817","M4317","Z515","T182XXA","J811","G7281","J9602","S2232XD","W07XXXA","I340","R509","F1010","Z5189","R000","I361","I5020","W19XXXD","S2232XA","R410","S4991XA","I82442","I82452"],"date":["2024-04-18","2025-08-25","2024-02-16","2024-11-25","2026-02-05","2025-05-27","2025-03-13","2026-02-06","2026-02-09","2023-10-30","2025-03-07","2025-08-21","2025-12-01","2024-12-04","2023-06-23","2023-10-21","2023-06-21","2025-11-17","2025-12-01","2026-02-05","2023-07-12","2023-07-13","2023-07-12","2025-11-04","2023-07-12","2025-07-18","2025-03-01","2025-05-13","2025-06-28","2025-06-28","2023-08-13","2025-05-27","2023-08-13","2023-08-13","2025-08-25","2024-11-18","2023-10-18","2024-08-12","2025-12-01","2023-09-18","2024-05-11","2023-10-14","2025-12-01","2023-10-14","2025-05-14","2025-03-08","2025-03-11","2025-08-21","2023-10-18","2025-08-22","2023-10-15","2025-03-20","2026-02-05","2023-11-03","2023-10-16","2024-08-08","2025-06-29","2023-10-31","2025-08-20","2024-01-30","2024-08-07","2024-08-12","2023-10-31","2023-10-31","2023-11-30","2023-12-11","2025-07-12","2026-02-09","2025-06-28","2025-06-28","2024-01-19","2024-01-23","2024-01-18","2024-01-18","2024-02-08","2024-07-05","2026-02-05","2024-07-05","2024-05-11","2025-07-12","2024-07-05","2024-07-05","2024-10-07","2025-07-06","2025-07-30","2025-03-18","2025-03-18","2025-03-13","2025-11-17","2024-08-12","2025-03-01","2025-03-01","2025-07-18","2025-11-04","2025-11-03","2025-06-28","2025-06-29","2025-07-05","2025-06-30","2024-12-04","2025-05-29","2024-12-04","2025-06-28","2025-06-29","2026-02-05","2024-08-07","2025-03-27","2025-12-01","2025-05-14","2025-05-14","2025-03-01","2025-03-01","2025-03-01","2024-11-18","2025-08-21","2025-12-01","2025-07-06","2025-07-06","2023-03-27","2025-03-20","2025-08-23","2025-08-23","2025-08-23","2025-08-23","2026-02-09","2025-05-19","2026-02-05","2025-09-04","2024-04-18","2025-08-25","2023-03-27","2025-10-07","2025-10-07","2025-10-07","2025-10-07","2025-08-21","2025-08-21","2025-06-28","2025-08-20","2025-03-07","2025-05-29","2026-02-05","2025-05-21","2025-03-13","2024-08-06","2024-11-16","2024-09-29","2023-04-01","2025-05-14","2025-05-14","2023-02-07","2023-02-07","2023-02-11","2023-02-17","2023-02-17","2023-02-17","2023-02-24","2023-02-09","2023-02-18","2023-02-18","2023-02-15","2023-02-06","2023-02-02","2023-02-02","2023-02-02","2023-02-03","2023-02-01","2023-01-31","2023-02-03","2023-02-03"],"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":[["","","NALTREXONE","50 MG","","Select","Select",""],["","","METOPROLOL SUCC","100 MG","","Select","Select",""],["","","CLONIDINE","0.1 MG","","Select","Select",""],["","","DISULFIRAM","250 MG","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","METOPROLOL TART","50 MG","","Select","Select",""],["","","OLANZAPINE ODT","","","Select","Select",""],["","","ENOXAPARIN PF","120 MG\/0.8","","Select","Select",""],["","","ACAMPROSATE","333 MG","","Select","Select",""],["","","OLANZAPINE","2.5 MG","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","SERTRALINE","50 MG","","Select","Select",""],["","","TRAZODONE","100 MG","","Select","Select",""],["","","LORAZEPAM","1 MG","","Select","Select",""],["","","OMEPRAZOLE","40 MG","","Select","Select",""],["","","LACTULOSE","10 GM\/15","","Select","Select",""],["","","POTASSIUM CL","20 MEQ","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","CELECOXIB","100 MG","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","Nystatin 100","","","Select","Select",""],["","","PANTOPRAZOLE","20 MG","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","ONDANSETRON HCL","","","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":""}]}]}