{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert L Gurganious","gend":0,"currentgend":"","add":"166 SOUTH HIGH ST","city":"BRIDGTON","state":"ME","zip":"04009","dob":"1964-01-17","age":"","mstatus":"","insh":"10000069942","cliId":"","pno":"9789309333","cno":"","email":"Robertlg39@live.com","ename":"","eno":"","pphy":"PIERKO, DARIUSZ R","ppno":"2076479021","pcpadd":"North Bridgton Family Practice,14 Wyonegonic Rd","pcpcity":"North Bridgton","pcpstate":"ME","pcpzip":"04057","pcpcounty":"","pcpid":"","pcpname":"NORTH BRIDGTON FAMILY PRACTICE AND WALK IN CLINIC","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 561","madd2":"","madd3":"","mcity":"BRIDGTON","mstate":"ME","mzip":"04009","pcpfaxno":"2076475932","pcpnpi":"1417074188","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8Y82KD1VN07","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E119","Z0000","R079","D649","C9110","Z8572","Z0101","G4733","R0600","I447","R0609","R6889","M19012","Z79899","I10","M151","S6990XA","M19041","R0789","C220","J0190","Z5112","E8721","C229","R591","K769","C8510","R161","K828","R300","C8335","R197","C801","D490","I5189","E1165","R918","R160","K7689","E1122","I129","N1830","R0602","Z029","R162","K5900","R519","N419","R1011","F411","C786","C859A","K219","R059","K449","R040","E8720","C221","Z83711","Z801","K5730","M542","M25512","M75102"],"date":["2026-02-26","2025-11-11","2025-02-11","2023-05-22","2023-06-05","2024-10-26","2023-08-17","2025-02-05","2026-02-05","2023-09-25","2023-09-25","2023-11-07","2024-01-25","2024-02-06","2024-02-29","2024-04-02","2024-04-01","2024-04-02","2025-01-27","2026-02-17","2025-06-09","2026-02-19","2025-06-25","2025-08-18","2025-02-13","2025-12-12","2025-01-20","2025-12-12","2025-12-12","2024-12-05","2024-12-04","2025-06-29","2024-10-17","2024-09-24","2026-02-09","2026-02-11","2025-09-30","2024-09-24","2025-10-17","2026-02-05","2026-02-05","2026-02-05","2026-02-05","2025-12-22","2024-09-20","2024-09-20","2024-09-20","2024-09-20","2024-09-09","2024-10-28","2024-10-02","2024-10-02","2024-10-02","2023-03-24","2024-09-27","2025-06-09","2025-06-25","2025-05-01","2025-05-01","2025-05-01","2024-09-07","2023-03-15","2023-03-15","2023-03-15"],"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":[["","","ESCITALOPRAM","20 MG","","Select","Select",""],["","","Mupirocin 2 % Ointment Padagis","","","Select","Select",""],["","","LORAZEPAM","0.5 MG","","Select","Select",""],["","","TRAZODONE","50 MG","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","LEVOTHYROXINE","50 MCG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","Embecta Nano 2Nd Gen (Ref 320550)","","","Select","Select",""],["","","ATENOLOL","50 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","TRESIBA FLEXTOUCH","","","Select","Select",""],["","","Amlodipine","10 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","ONDANSETRON","8 MG","","Select","Select",""],["","","DRONABINOL","5 MG","","Select","Select",""],["","","Diclofenac Sod 1 % Gel Cipla","","","Select","Select",""],["","","TAMSULOSIN","0.4 MG","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ANDRODERM","","","Select","Select",""],["","","LISINOPRIL","20 MG","","Select","Select",""],["","","Novolog Flexpen","","","Select","Select",""],["","","TOUJEO MAX SOLOSTAR","","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","ROSUVASTATIN","20 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","ARIPIPRAZOLE","5 MG","","Select","Select",""],["","","HYDROXYZINE HCL","25 MG","","Select","Select",""],["","","Dexcom G7 Sensor","","","Select","Select",""],["","","FLEXTOUCH","","","Select","Select",""],["","","Hydrocortisone 2.5 % Cream Fougera","","","Select","Select",""],["","","TOUJEO SOLOSTAR","","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","Insulin Aspart Flexpen","","","Select","Select",""],["","","QUETIAPINE","50 MG","","Select","Select",""],["","","Diclofenac Sod 1 % Gel Encube","","","Select","Select",""],["","","DEXCOM G","","","Select","Select",""],["","","DICLOFENAC SOD","0.01","","Select","Select",""],["","","HYDROCORTISONE","0.025","","Select","Select",""],["","","MUPIROCIN","0.02","","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":""}]}]}