{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Walter C Swenson","gend":0,"currentgend":"","add":"105 BIRCH HILL ESTATES","city":"Bangor","state":"ME","zip":"04401","dob":"1939-10-26","age":"","mstatus":"","insh":"00008265400","cliId":"","pno":2074610304,"cno":"","email":"declined@083022.com","ename":"","eno":"","pphy":"RONCO, PAUL G","ppno":2079476141,"pcpadd":"43 WHITING HILL RD,SUITE 300","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121005","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"105 BIRCH HILL ESTATES","madd2":"","madd3":"","mcity":"Bangor","mstate":"ME","mzip":"04401","pcpfaxno":2079476720,"pcpnpi":1033152582,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7EA3U11DN89","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N189","Z5181","G319","I4891","I5020","I6782","Z0100","I493","I4720","I491","I4710","Z23","R1310","R6330","L570","K219","Z7901","M79661","I77819","E785","N1830","Z0001","I739","D693","E039","K2090","K922","S81831A","I4892","I10","D649","I2510","G450","R270","R001","I4819","L821","D229","L814","D225","R079","Z01818","R9439","I444","I429","I130","E1151","I214","H26492","I4510","Z09","K2270","Z4801","I6523","I4820","Z0000","F17290","Z7982","I160","K2281","H18513","H43813","H18233","K449","K224","K921","Z79899","L820","L298","F17200","I480","I081","I517"],"date":["2024-09-01","2025-08-06","2024-09-10","2025-07-28","2022-11-08","2024-09-10","2025-08-06","2025-07-28","2024-08-09","2025-07-28","2024-08-09","2024-09-25","2024-01-18","2023-04-21","2024-08-27","2024-04-19","2025-05-13","2024-02-21","2022-11-01","2022-11-01","2022-11-01","2023-01-10","2023-01-10","2023-01-10","2023-01-10","2024-01-18","2025-03-13","2024-07-15","2025-07-28","2025-06-25","2025-06-26","2024-10-23","2024-08-02","2024-08-02","2024-08-02","2024-06-20","2023-08-24","2023-08-24","2023-08-24","2023-08-24","2024-06-01","2023-04-17","2023-02-13","2023-02-13","2023-01-16","2022-12-15","2022-12-15","2024-06-04","2023-07-11","2024-06-01","2024-06-18","2023-02-06","2024-06-06","2024-08-02","2023-08-03","2024-10-07","2024-10-07","2024-10-07","2024-05-28","2023-04-21","2023-05-31","2023-05-31","2023-05-31","2023-10-25","2023-02-06","2025-06-26","2025-06-25","2022-08-23","2022-08-23","2022-08-23","2022-08-16","2022-08-16","2022-07-08"],"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":[]},{"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":""}]}]}