{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Roger Cyr","gend":0,"currentgend":"","add":"119 THIRD AVE","city":"Madawaska","state":"ME","zip":"04756","dob":"1947-12-12","age":"","mstatus":"","insh":"10000009728","cliId":"","pno":2077284529,"cno":"","email":"rdcyr50@yahoo.com","ename":"","eno":"","pphy":"ENO, LISA M","ppno":2078346784,"pcpadd":"194 EAST MAIN STREET,","pcpcity":"FORT KENT","pcpstate":"ME","pcpzip":"04743","pcpcounty":"","pcpid":"","pcpname":"NMMC MEDICAL PRACTICES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"119 THIRD AVE","madd2":"","madd3":"","mcity":"Madawaska","mstate":"ME","mzip":"04756","pcpfaxno":2078342967,"pcpnpi":1003898677,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9M32JE5GP22","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z48810","E785","Z0100","H35373","N400","R9720","C61","I371","I071","H43811","Z961","H52223","H524","R0602","H26491","I4891","H2512","Z0101","R6889","K4090","G8918","I10","Z23","Z01818","R351","R339","R3912","Z0000","H259","Z8546","Z79899","K4020","Z712","Z7901","H2511","R69","R509","I959","R000","I081","I2722","N390","Z7289"],"date":["2025-05-06","2025-01-17","2024-11-12","2023-10-23","2025-05-30","2022-10-25","2025-05-16","2025-02-05","2025-02-05","2025-07-01","2025-06-26","2025-06-26","2025-06-26","2025-02-26","2025-08-19","2024-12-20","2025-02-13","2022-10-20","2022-10-17","2023-06-15","2023-06-15","2023-11-03","2025-02-26","2025-02-03","2023-11-14","2023-11-14","2023-11-14","2025-01-14","2025-03-21","2025-05-30","2025-05-30","2023-05-26","2023-05-26","2023-05-26","2025-03-27","2022-09-16","2022-08-29","2022-08-29","2022-09-01","2022-09-02","2022-09-02","2022-09-04","2022-09-04"],"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":[["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","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":""}]}]}