{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Diana G Fowles","gend":1,"currentgend":"","add":"418 GREENVILLE ROAD","city":"MONSON","state":"ME","zip":"04464","dob":"1948-05-27","age":"","mstatus":"","insh":"10000025275","cliId":"","pno":2079973951,"cno":2072165618,"email":"rfowles1@hotmail.com","ename":"","eno":"","pphy":"DRUAN, KRISTEN","ppno":2079073300,"pcpadd":"C\/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT,PO BOX 7291","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42437291","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"P O BOX 52","madd2":"","madd3":"","mcity":"MONSON","mstate":"ME","mzip":"04464","pcpfaxno":2079071923,"pcpnpi":1770911430,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5HK8T41AU52","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0101","H524","H2513","M1712","I10","M25561","R6889","K5720","Z5331","M79672","K5790","E669","I491","I459","I252","G4733","S62315A","F419","K219","Z0000","Z1231","Z01810","Z8774","E6609","M2242","M76892","S83412A","S83422A","E538","J4520","Z9049","M7989","W19XXXA","Z951","R051","K5792","R1030","R935","Z91041","M170","K5730","N3289","K429","K4090","E559","S99922A","F320","R053","S92342A","Z0130","K5732","M25562","M25462"],"date":["2024-04-03","2022-11-29","2022-11-29","2025-09-12","2025-10-29","2023-02-06","2023-10-01","2023-07-26","2023-07-26","2025-09-12","2023-07-26","2023-07-26","2023-06-16","2023-06-16","2023-06-16","2025-07-23","2025-08-16","2024-12-12","2022-12-08","2025-04-24","2022-12-08","2023-06-13","2023-06-13","2023-06-13","2022-12-15","2022-12-15","2022-12-15","2022-12-15","2025-04-24","2024-12-12","2024-12-12","2025-08-16","2025-08-16","2023-06-08","2025-02-17","2023-06-08","2023-05-19","2023-05-19","2023-05-19","2024-01-02","2023-07-03","2023-07-03","2023-07-03","2023-07-03","2025-04-24","2025-08-16","2025-10-29","2025-10-29","2025-08-16","2023-01-19","2023-05-19","2022-10-20","2022-10-20"],"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":[["","","FLUOXETINE HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","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":""}]}]}