{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marsha C Mahoney","gend":1,"currentgend":"","add":"142 Gould Rd","city":"Dayton","state":"ME","zip":"04005","dob":"1943-11-20","age":"","mstatus":"","insh":"10000020802","cliId":"","pno":2072864656,"cno":"","email":"DECLINED@12232024.COM","ename":"","eno":"","pphy":"CORBETT, IAN J","ppno":"","pcpadd":"Northern Light Mercy Primary Care South Portland,225 Gorham Rd Ste 303","pcpcity":"South Portland","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE SOUTH PORTLAND","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"142 Gould Rd","madd2":"","madd3":"","mcity":"Dayton","mstate":"ME","mzip":"04005","pcpfaxno":2078287850,"pcpnpi":1770149916,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1EX9HT3ET51","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N1831","E785","I10","I5032","R197","Z7982","M7989","R0602","Z0000","R0989","I779","R0609","M5450","M25551","Z0100","Z961","H43813","H52223","I371","I130","M5136","M47816","M4316","K921","R42","K5900","D492","D23112","D23122","L918","N1830","R6889","I6523","D485","D751","R531","Z79899","Z87891","N189","R002","R0600"],"date":["2025-10-01","2024-10-09","2025-10-01","2025-10-01","2025-06-20","2024-05-21","2024-07-08","2023-11-06","2025-09-15","2025-06-02","2023-08-15","2025-10-01","2024-06-26","2024-06-26","2025-07-02","2025-07-02","2025-07-02","2025-07-02","2025-09-10","2025-07-07","2024-06-26","2024-06-26","2024-06-26","2023-10-20","2023-10-20","2023-10-20","2024-11-05","2025-01-16","2024-11-05","2024-11-05","2025-06-02","2023-06-06","2025-08-27","2024-11-05","2025-06-18","2025-05-29","2025-05-26","2025-05-26","2025-06-27","2025-08-27","2022-06-15"],"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":[["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","BETAMETHASONE VALERATE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}