{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rebecca D Henderson","gend":1,"currentgend":"","add":"19 PARK ST UNIT 102","city":"Fort Kent","state":"ME","zip":"04743","dob":"1947-08-07","age":"","mstatus":"","insh":"10000024027","cliId":"","pno":2072315170,"cno":"","email":"","ename":"","eno":"","pphy":"GRANGE, CAMERON L","ppno":2074445973,"pcpadd":"12 BOLDUC AVE,","pcpcity":"FORT KENT","pcpstate":"ME","pcpzip":"47431602","pcpcounty":"","pcpid":"","pcpname":"FISH RIVER RURAL HEALTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"19 PARK ST UNIT 102","madd2":"","madd3":"","mcity":"Fort Kent","mstate":"ME","mzip":"04743","pcpfaxno":2074445520,"pcpnpi":1023329000,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5A85YF6PX74","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S72431A","G20C","M810","M6281","R262","M25551","Z96641","M79671","M25562","G20B2","M25559","M25512","M25571","M25561","M25511","R300","S72401P","S82141D","W109XXD","S8991XA","S82121A","S72001A","D649","R252","R1084","R531","G20A1","G249","R634","G20B1","T887XXA","K5792","S7001XA","W1830XA","Y92010","Z79899","Z9989","G20A2","Y939","G20","Z23","Z299","Z0000","E538","I10","E559","R636","K56600","Z87891"],"date":["2025-07-04","2025-04-29","2025-04-29","2025-04-29","2025-04-29","2025-06-12","2025-06-12","2025-07-01","2025-07-01","2025-01-27","2025-01-27","2025-07-01","2025-07-01","2025-07-01","2025-07-01","2025-07-01","2025-08-11","2025-08-11","2025-08-11","2025-08-11","2025-07-04","2025-07-04","2024-05-15","2024-05-15","2024-07-25","2024-07-25","2024-12-03","2024-12-20","2024-06-20","2024-11-07","2024-11-18","2024-07-25","2024-06-22","2024-06-22","2024-06-22","2024-10-11","2024-02-29","2024-07-10","2024-06-22","2023-08-08","2022-12-20","2022-12-20","2024-07-31","2024-08-21","2024-03-18","2024-06-20","2024-06-20","2024-11-05","2024-10-11"],"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":[["","","CARBIDOPA-LEVODOPA ER","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","CARBIDOPA-LEVODOPA","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","ROPINIROLE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","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":{"indx":[["","","",""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}