{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marilyn A Bain","gend":1,"currentgend":"","add":"6008 FAIRWAY DR","city":"Carrabassett Valley","state":"ME","zip":"04947","dob":"1936-06-05","age":"","mstatus":"","insh":"10000007612","cliId":"","pno":2072373435,"cno":"","email":"none@04.05.2011.com","ename":"","eno":"","pphy":"MILLER, ROY S","ppno":2075497581,"pcpadd":"PO BOX 207,","pcpcity":"COOPERS MILLS","pcpstate":"ME","pcpzip":"43410207","pcpcounty":"","pcpid":"","pcpname":"SHEEPSCOT VALLEY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2072373435,"add2":"","add3":"","madd1":"PO BOX 399","madd2":"","madd3":"","mcity":"Stratton","mstate":"ME","mzip":"04982","pcpfaxno":"","pcpnpi":1700854361,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8E83EJ1PP08","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E039","I5A","F03A0","M25531","M19031","K5730","R935","R1030","K760","M1310","F0390","R300","L84","Z09","R7989","Z9049","K828","R109","Z23","I440","R9431","N390","F03C0","I252","I214","R1084","R110","R55","I444","I517","S63501A","R001","H6120","R42","E785","I4891","Z7901","M79631","M7989","M85831","E559","F03B0","R21"],"date":["2024-11-06","2024-07-26","2023-02-03","2024-01-28","2024-01-28","2024-08-24","2024-08-24","2024-08-24","2024-08-24","2024-01-28","2024-01-28","2024-11-14","2025-05-02","2024-08-01","2024-10-08","2024-10-08","2024-10-08","2024-08-24","2024-11-06","2024-08-04","2024-07-28","2024-05-18","2024-05-18","2025-04-28","2024-07-27","2024-10-08","2024-08-04","2024-08-04","2024-08-04","2024-08-04","2023-12-02","2023-10-13","2023-10-11","2023-10-11","2024-11-06","2023-12-02","2023-12-02","2023-12-02","2023-12-02","2023-12-02","2022-10-12","2022-10-12","2022-08-25"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","HYDROCORTISONE","","","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":""}]}]}