{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert D Marciniak","gend":0,"currentgend":"","add":"28 CHESTNUT HEIGHTS ROAD","city":"Gray","state":"ME","zip":"04039","dob":"1950-09-27","age":"","mstatus":"","insh":"10000043595","cliId":"","pno":"2077126214","cno":"","email":"donna.marciniak@gmail.com","ename":"","eno":"","pphy":"CASSIN, JARED","ppno":"2077811600","pcpadd":"MMP Falmouth Internal Medicine,5 Bucknam Rd Ste 2B","pcpcity":"Falmouth","pcpstate":"ME","pcpzip":"04105","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"28 CHESTNUT HEIGHTS ROAD","madd2":"","madd3":"","mcity":"Gray","mstate":"ME","mzip":"04039","pcpfaxno":"2077811609","pcpnpi":"1780094243","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7AF0EN2MN13","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N390","R319","R197","Z950","I442","Z0000","I700","I10","R8290","Z45018","R051","J069","I2510","Z8546","Z87891","R079","I5189","Z136","I083","R0789","I200","J986","I25110","L821","I5030","R931","L820","L538","L298","H40013","Z0101","Z955","M9905","M5442","G8929","M9906","M160","M25551","M5117","M4726","M4317","M25552","M5432","I498"],"date":["2023-06-07","2023-06-07","2023-06-07","2024-06-25","2024-02-12","2023-06-16","2023-06-16","2024-02-12","2023-06-27","2023-09-20","2023-10-17","2023-10-13","2024-04-29","2023-10-13","2024-03-19","2024-03-19","2024-01-13","2024-01-13","2024-02-12","2024-02-06","2024-02-12","2024-02-09","2024-05-03","2024-02-16","2024-02-12","2024-02-12","2024-03-04","2024-03-04","2024-03-04","2024-03-04","2024-03-04","2024-06-03","2024-04-17","2024-04-17","2024-04-17","2024-04-17","2024-06-17","2024-06-17","2024-06-17","2024-06-17","2024-06-17","2024-06-17","2024-06-17","2024-06-03"],"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":[["","","Metoprolol Succ","100 MG","","Select","Select",""],["","","Abrysvo W\/ Diluent Syringe","","","Select","Select",""],["","","Atorvastatin","80 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Propranolol","80 MG","","Select","Select",""],["","","Cefdinir","300 MG","","Select","Select",""],["","","Isosorbide Mononitrate","30 MG","","Select","Select",""],["","","Rosuvastatin","20 MG","","Select","Select",""],["","","Prevnar 20","","","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":""}]}]}