{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Martin M Liebau","gend":0,"currentgend":"","add":"24 MAURICE DRIVE","city":"Brunswick","state":"ME","zip":"04011","dob":"1937-11-26","age":"","mstatus":"","insh":"10000086423","cliId":"","pno":"2072426091","cno":"","email":"Rftaylor60@gmail.com","ename":"","eno":"","pphy":"BAIER, ROBIN","ppno":"2077984400","pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"24 MAURICE DRIVE","madd2":"","madd3":"","mcity":"Brunswick","mstate":"ME","mzip":"04011","pcpfaxno":"2078287850","pcpnpi":"1891189288","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8NR5FT5NH58","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":["B351","M79674","M79675","N1831","Z13220","Z23","M79605","I442","L97529","Z950","L03115","L03116","L089","I110","I509","E039","A000","R079","I5031","F03918","N1832","Z515","E785","I314","S91102D","L97519","G9340","I130","Z0389","S81802D","N189","E162","I998","I319","R918","C9000","J90","J9811","M79662","I351","I358","I5189","R001","L0390","I2720","I447","M7989","I517","Z95818","I3139","S91102A","B871","I872","I878","L03032","R600","M19072","M7732","M7662","R4182","Z743"],"date":["2025-11-19","2025-11-19","2025-11-19","2025-11-09","2024-03-07","2024-09-23","2024-09-22","2024-10-04","2025-12-04","2026-02-20","2025-08-29","2025-08-29","2025-10-29","2024-09-24","2025-10-29","2024-09-24","2025-09-05","2025-11-10","2024-10-04","2024-10-04","2024-09-23","2024-09-23","2025-03-10","2024-10-04","2026-01-29","2025-10-05","2024-09-30","2024-11-28","2026-01-06","2026-02-18","2024-09-23","2024-08-28","2026-01-06","2024-09-25","2024-09-24","2024-09-25","2024-10-01","2024-09-25","2025-11-10","2024-10-01","2024-10-01","2024-10-01","2024-08-28","2025-08-26","2024-08-28","2024-08-28","2025-11-10","2025-11-10","2024-09-25","2024-09-25","2026-01-06","2025-10-29","2026-01-03","2025-11-10","2025-08-29","2025-11-09","2025-10-29","2025-10-29","2025-10-29","2025-11-10","2025-11-10"],"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":[["","","FLUAD","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE","","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","Ciclopirox 0.77 % Cream Glenmark","","","Select","Select",""],["","","OSELTAMIVIR","75 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","TERBINAFINE","250 MG","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUAD QUAD","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","CICLOPIROX","0.0077","","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":""}]}]}