{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carol M Rice","gend":1,"currentgend":"","add":"8 WHITING AVE","city":"WATERFORD","state":"ME","zip":"04088","dob":"1943-10-13","age":"","mstatus":"","insh":"00008386400","cliId":"","pno":2075151912,"cno":"","email":"13CMRice@gmail.com","ename":"","eno":"","pphy":"MOHAN, ELIZABETH A","ppno":"","pcpadd":"100 GANNETT DR STE C,","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41065900","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 163","madd2":"","madd3":"","mcity":"WATERFORD","mstate":"ME","mzip":"04088","pcpfaxno":"","pcpnpi":1952622151,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9FG5MY4XR67","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L719","L821","L578","D225","Z1231","M4317","M4184","Z23","M79604","M5410","M79651","M7989","R519","R509","E7800","I10","M51360","M47818","M5416","M4185","M47816","R2241","M4126","M8588","M810","R300","M1711","M25511","G8929","M75101","M19011","R8290","Z0000","Z131","Z0001","I77810","N390","E871","D696","M25561","R222","M5116","M4727","L600","M79674","M79675","M25461","N3091","H26493","H15833","Z0101","M5450","R6889","H53143","I471","W19XXXA","L918","S3992XA","W1849XA","R0781","M549","M5134","M419","M5137","D492","L820","L570","R002","E870","D751","R030","H26491"],"date":["2023-06-26","2023-06-26","2023-06-26","2023-06-26","2025-01-16","2025-07-14","2024-10-02","2025-11-03","2024-04-17","2024-04-17","2024-04-17","2024-03-05","2024-08-27","2024-06-30","2025-05-12","2025-05-12","2024-10-02","2025-06-03","2025-07-14","2024-10-02","2025-03-27","2024-03-05","2024-12-11","2024-12-09","2024-12-09","2025-02-20","2025-06-12","2025-06-12","2024-10-02","2025-06-12","2025-06-12","2023-04-10","2023-04-10","2024-05-20","2025-05-19","2024-12-09","2024-07-17","2024-07-03","2024-07-03","2024-01-05","2024-02-07","2025-07-14","2025-07-14","2025-11-04","2025-08-14","2025-08-14","2023-11-28","2024-06-30","2023-03-27","2023-11-07","2023-11-07","2024-10-16","2023-11-07","2022-11-16","2022-10-03","2022-10-03","2022-07-26","2022-07-11","2022-07-11","2022-07-11","2022-07-11","2022-07-11","2022-07-11","2022-07-11","2022-06-28","2022-06-29","2022-06-29","2022-05-09","2022-05-09","2022-03-28","2022-03-28","2022-01-26"],"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":[["","","NEOMYCIN-POLYMYXIN-HYDROCORT","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","OXYCODONE HCL","","","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":""}]}]}