{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Linda P Hunt","gend":1,"currentgend":"","add":"758 BROADWAY APT 8","city":"Bangor","state":"ME","zip":"04401","dob":"1947-02-25","age":"","mstatus":"","insh":"10000028089","cliId":"","pno":2074609546,"cno":"","email":"wickedwhisk@roadrunner.com","ename":"","eno":"","pphy":"PEPPER, CINDY E","ppno":2074697371,"pcpadd":"110 BROADWAY,","pcpcity":"BUCKSPORT","pcpstate":"ME","pcpzip":"44164612","pcpcounty":"","pcpid":"","pcpname":"BUCKSPORT REGIONAL HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"758 BROADWAY APT 8","madd2":"","madd3":"","mcity":"Bangor","mstate":"ME","mzip":"04401","pcpfaxno":"","pcpnpi":1104867290,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7K59U17NC45","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H3023","H40043","H35353","H35013","G912","Z79899","Z713","R2681","S93412S","R269","G20A1","H209","G20B1","Z87891","Z0101","G20B2","H4053X3","H409","H43813","H401133","H17821","R296","E1169","R5383","M549","N3281","H04123","E119","H4010X3","H2013","R29898","N6313","M5410","R920","Z043","R5381","R2689","Z0000","R928","Z789","H401123","H18232","M25572","M79674","M79675","B351","M7989","Z0189","M5450","Z13820","M8589","N6489","R921","G971","N649","S329XXA","Z7401","R4182","R0600","R278","I959","N390","Z79620","R4789","R634","M5459","H44113","G20C","A7741","Z119","R410","H35033","H4041X2","M4316","M4186","M5137","M47816"],"date":["2025-03-27","2025-03-27","2025-03-27","2025-03-27","2025-09-12","2025-09-12","2024-12-11","2024-09-05","2024-08-16","2025-08-22","2025-08-27","2025-07-02","2025-09-12","2025-09-12","2024-11-07","2025-06-26","2024-05-07","2023-09-14","2025-06-23","2023-12-13","2023-12-13","2025-08-15","2025-04-16","2023-06-27","2023-10-16","2023-06-27","2023-06-27","2025-04-16","2022-12-19","2023-08-15","2025-08-26","2023-10-06","2023-10-10","2025-04-07","2025-08-22","2025-08-16","2024-01-02","2024-07-02","2022-12-05","2022-12-05","2024-02-29","2024-02-29","2024-05-28","2025-06-04","2025-06-04","2025-06-04","2024-04-03","2025-08-27","2024-03-25","2023-04-05","2023-04-05","2023-04-07","2025-04-07","2024-03-19","2023-04-07","2025-08-25","2025-08-27","2025-08-27","2025-08-26","2023-11-06","2025-05-15","2025-08-27","2025-08-26","2023-11-17","2022-10-13","2022-10-06","2022-11-02","2025-05-07","2025-07-23","2025-07-23","2025-08-27","2022-09-29","2022-09-29","2022-09-15","2022-09-15","2022-09-14","2022-09-14"],"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":[["","","METHOTREXATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","BRIMONIDINE TARTRATE-TIMOLOL","","","Select","Select",""],["","","CARBIDOPA-LEVODOPA","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","COMBIGAN","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","BRIMONIDINE TARTRATE","","","Select","Select",""],["","","MIRTAZAPINE","","","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":{"indx":[],"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":""}]}]}