{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Raoul Campagna","gend":0,"currentgend":"","add":"818 MAIN ST","city":"Madawaska","state":"ME","zip":"04756","dob":"1933-06-24","age":"","mstatus":"","insh":"00007854000","cliId":"","pno":2077284958,"cno":"","email":"DECLINED@01232025.COM","ename":"","eno":"","pphy":"MANAGES, SAMUELA E","ppno":2078343155,"pcpadd":"PO BOX 40,","pcpcity":"CARIBOU","pcpstate":"ME","pcpzip":"47360040","pcpcounty":"","pcpid":"","pcpname":"PINES ST JOHN VALLEY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2077284958,"add2":"","add3":"","madd1":"818 MAIN ST","madd2":"","madd3":"","mcity":"Madawaska","mstate":"ME","mzip":"04756","pcpfaxno":2074983947,"pcpnpi":1750549044,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5Q70WW2TY35","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R339","Z739","T83098A","Z466","R319","N401","R338","D649","E119","T148XXS","R011","N390","S51812A","H40033","L309","N3001","K5900","S91119A","T839XXA","E1142","I10","Y828","E860","Z7984","T83011A","B9689","R300","Z79899","Z87891","R369","N3000","T83091A","N400","E1129","M25471","K4030","R296","T83028A","R1084","Z7689"],"date":["2025-08-17","2025-03-01","2024-03-26","2025-09-17","2023-10-30","2024-02-16","2023-11-20","2023-10-30","2025-01-21","2025-05-13","2023-01-19","2023-10-24","2025-03-10","2024-05-20","2024-03-07","2023-10-25","2023-10-17","2025-03-14","2023-10-26","2024-06-25","2024-06-25","2023-12-26","2023-10-23","2023-10-23","2025-09-11","2023-10-24","2023-10-24","2024-03-26","2024-03-26","2023-12-21","2025-03-20","2025-07-02","2024-01-04","2025-06-25","2023-01-19","2023-10-19","2024-11-29","2025-07-04","2023-10-17","2024-01-08"],"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":[["","","TAMSULOSIN HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","BRIMONIDINE TARTRATE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","ENALAPRIL MALEATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","TIMOLOL MALEATE","","","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":""}]}]}