{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Yvette M Leblanc","gend":1,"currentgend":"","add":"125 ALPINE ST","city":"South Paris","state":"ME","zip":"04281","dob":"1946-05-29","age":"","mstatus":"","insh":"00008203200","cliId":"","pno":2074187305,"cno":"","email":"yleblanc1946@yahoo.com","ename":"","eno":"","pphy":"DAOUD, SAID G","ppno":2077955700,"pcpadd":"Swift River Family Medicine,430 Franklin St","pcpcity":"Rumford","pcpstate":"ME","pcpzip":"04276","pcpcounty":"","pcpid":"","pcpname":"SWIFT RIVER FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"74 MCKENNEY RD","madd2":"","madd3":"","mcity":"Saco","mstate":"ME","mzip":"04072","pcpfaxno":2073691182,"pcpnpi":1881775864,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3CW3JT1QP77","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R41841","M5459","I10","G9009","Z0101","C44319","Z1231","Z23","R300","H353131","N952","G3184","F32A","L98499","H6691","T700XXA","R251","R2681","M47816","R109","L905","R079","Z13228","F411","F01B18","R351","R410","N390","Z111","R309","N3001","M25512","R238","Z87440","R4182","M549","R3915","N3000","Z0000","E7800","C44310","R42","R6883","R5383","B961","R413","E83119"],"date":["2025-04-15","2025-04-15","2025-10-22","2025-04-15","2024-07-09","2024-01-23","2024-08-06","2025-11-11","2024-10-28","2024-07-09","2022-11-28","2025-10-22","2025-10-22","2023-09-15","2023-05-02","2023-04-12","2024-10-25","2024-10-25","2024-09-07","2024-10-25","2024-01-23","2024-10-25","2025-11-05","2024-05-28","2024-05-28","2024-10-22","2024-12-31","2025-10-28","2024-03-25","2025-01-16","2023-08-10","2024-10-25","2023-06-27","2024-11-08","2024-10-25","2024-10-25","2024-09-24","2024-10-28","2024-08-06","2024-10-08","2023-12-06","2025-01-13","2025-01-13","2025-01-13","2024-09-27","2022-10-11","2022-09-30"],"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":[]},{"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":""}]}]}