{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Martha K Bangs","gend":1,"currentgend":"","add":"362 CEDAR GROVE RD","city":"Dresden","state":"ME","zip":"04342","dob":"1946-07-01","age":"","mstatus":"","insh":"10000028467","cliId":"","pno":2077372279,"cno":"","email":"gbangs@roadrunner.com","ename":"","eno":"","pphy":"HACKETT, MELISSA C","ppno":2077374359,"pcpadd":"Richmond Area Health Center,24 Gardiner St","pcpcity":"Richmond","pcpstate":"ME","pcpzip":"04357","pcpcounty":"","pcpid":"","pcpname":"RICHMOND AREA HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"362 CEDAR GROVE RD","madd2":"","madd3":"","mcity":"Dresden","mstate":"ME","mzip":"04342","pcpfaxno":2077374412,"pcpnpi":1902170392,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9KU3FK4TG99","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R309","R6889","Z0101","N3001","R319","R300","R350","R3915","H04123","I080","R931","R21","I480","R7989","R0609","I4891","R946","R002","R42","E785","Z7189","D649","F419","I4710","M25552","R030","R0602","I471","Z136","F411","E041","I6523","M160","M47816","M1612","Z0000","Z13820","Z780"],"date":["2025-09-14","2022-01-01","2024-11-06","2023-08-22","2023-01-02","2025-09-14","2025-09-14","2025-09-14","2024-11-06","2025-10-02","2025-10-02","2023-09-26","2023-01-09","2023-01-09","2025-01-15","2023-01-09","2023-01-09","2023-01-09","2023-01-09","2025-05-20","2025-05-20","2024-10-16","2024-07-10","2024-07-10","2024-10-16","2024-03-27","2025-10-02","2023-03-01","2024-12-20","2025-01-15","2025-01-15","2024-11-29","2024-03-27","2024-03-27","2024-03-27","2024-05-07","2024-05-07","2024-05-07"],"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":[["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":""}]}]}