{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Saviors Natole","gend":0,"currentgend":"","add":"446 BOG RD","city":"Vassalboro","state":"ME","zip":"04989","dob":"1946-12-15","age":"","mstatus":"","insh":"10000029016","cliId":"","pno":2076927098,"cno":"","email":"declined@08132025.com","ename":"","eno":"","pphy":"MCDONALD, JULIA","ppno":2076261561,"pcpadd":"Maine Dartmouth Family Medicine,149 North St Dept Family Med","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"MAINE DARTMOUTH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"446 BOG RD","madd2":"","madd3":"","mcity":"Vassalboro","mstate":"ME","mzip":"04989","pcpfaxno":2076261902,"pcpnpi":1477849073,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9DQ3X46KR94","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M160","R490","R1310","K219","Z1283","K2100","D649","N1830","E559","E785","I352","I4891","D1801","M25552","M7062","L821","L814","D225","I358","L570","K319","L820","K449","L853","Z0000","Z23","S70361D","W57XXXD","Z5189","R6330"],"date":["2023-06-13","2023-03-16","2023-02-17","2025-04-14","2025-11-13","2023-03-16","2025-09-03","2025-09-03","2025-09-03","2025-10-02","2025-07-29","2025-09-30","2025-11-13","2023-06-13","2023-10-31","2025-11-13","2025-11-13","2024-12-04","2025-09-03","2025-11-13","2023-02-17","2024-12-04","2023-03-16","2022-11-10","2022-11-22","2022-11-22","2022-11-22","2022-11-22","2022-09-02","2022-08-10"],"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":[["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","NYSTATIN","","","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":""}]}]}