{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Paul L Gravel","gend":0,"currentgend":"","add":"17 SWIFT RIVER RD","city":"MEXICO","state":"ME","zip":"04257","dob":"1963-03-10","age":"","mstatus":"","insh":"00008474300","cliId":"","pno":2073643212,"cno":"","email":"declined@082119.com","ename":"","eno":"","pphy":"LEEDS, JESSE","ppno":"","pcpadd":"149 NORTH ST,","pcpcity":"WATERVILLE","pcpstate":"ME","pcpzip":"49014974","pcpcounty":"","pcpid":"","pcpname":"SWIFT RIVER FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 69","madd2":"","madd3":"","mcity":"MEXICO","mstate":"ME","mzip":"04257","pcpfaxno":2078615001,"pcpnpi":1487279162,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8VK8DK2YN56","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C499","K5651","I10","R109","K56609","I83892","M47816","C179","C7800","Z79899","Z1211","R1033","Z08","R079","Z981","M5416","R2242","M25561","D120","I872","R195","Z4682","Z9049","K8020","C494","M5440","S40262A","Z1212","K5900","M7989"],"date":["2025-09-17","2024-08-06","2023-09-08","2024-08-06","2024-08-21","2024-09-06","2025-05-05","2024-12-06","2025-09-17","2025-09-16","2024-06-28","2024-04-27","2024-12-06","2024-04-27","2023-03-21","2023-03-21","2024-05-08","2023-08-21","2024-06-28","2024-09-06","2024-02-20","2024-04-28","2024-08-30","2024-08-06","2024-11-04","2023-10-30","2025-07-07","2024-04-02","2024-04-09","2024-05-08"],"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":[["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","DIVALPROEX SODIUM ER","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","DIVALPROEX SODIUM","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","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":""}]}]}