{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Helen White Water","gend":1,"currentgend":"","add":"178 B RIVER RD","city":"TOPSHAM","state":"ME","zip":"04086","dob":"1946-12-23","age":"","mstatus":"","insh":"10000027026","cliId":"","pno":2072080852,"cno":"","email":"helen@riverviewfoundation.org","ename":"","eno":"","pphy":"WALL, ELIZABETH T","ppno":2077984400,"pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"178 B RIVER RD","madd2":"","madd3":"","mcity":"TOPSHAM","mstate":"ME","mzip":"04086","pcpfaxno":2078287850,"pcpnpi":1598793762,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9R03PK2AU93","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K52839","M47814","M19071","K623","K5641","M47816","K5000","R42","I771","I6522","I10","K5090","R058","K30","S61411A","I739","Z79899","J029","R059","M79641","M19041","M1811","E673","Z0101","H04123","Z961","D3131","H5203","H52223","H524","M8580","D729","M79671","M5450","S61210A","S61212A","S61214A","I6523","Z0001","M419","R29890","M546","L821","D229","K648","K52832","Z780","M7741","M21621","R079","K449","I517","S61204A","L814","I491","M8588","H5201","R197","K529","K5730","K591","N812"],"date":["2023-01-05","2023-08-30","2023-08-30","2025-11-12","2025-11-12","2023-08-30","2025-10-23","2024-04-11","2024-04-11","2024-04-11","2025-11-04","2025-11-04","2025-11-04","2025-11-04","2025-07-18","2024-09-05","2025-09-10","2024-11-01","2025-11-04","2025-07-07","2025-07-07","2025-07-07","2023-01-05","2025-05-21","2023-05-10","2023-05-10","2023-05-10","2024-05-14","2025-05-21","2025-05-21","2025-09-10","2025-10-06","2023-08-30","2023-08-30","2025-07-07","2025-07-07","2025-07-07","2024-04-11","2023-08-21","2023-08-21","2023-08-21","2025-04-01","2025-11-05","2025-11-05","2025-10-23","2023-07-06","2025-06-18","2023-09-19","2023-09-19","2025-04-01","2025-04-01","2025-04-01","2025-07-07","2023-11-01","2025-04-01","2025-06-18","2025-05-21","2022-11-23","2022-11-23","2022-11-23","2022-09-22","2022-08-08"],"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":[["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","ESTRADIOL","","","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":""}]}]}