{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Wilma P Mounce","gend":1,"currentgend":"","add":"241 SENATOR BLACK RD","city":"West Baldwin","state":"ME","zip":"04091","dob":"1937-10-14","age":"","mstatus":"","insh":"10000031328","cliId":"","pno":2072452189,"cno":"","email":"wpmounce@gmail.com","ename":"","eno":"","pphy":"LENART, LORI","ppno":2076258126,"pcpadd":"Sacopee Valley Health Center,70 Main St","pcpcity":"Porter","pcpstate":"ME","pcpzip":"04068","pcpcounty":"","pcpid":"","pcpname":"SACOPEE VALLEY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"241 SENATOR BLACK RD","madd2":"","madd3":"","mcity":"West Baldwin","mstate":"ME","mzip":"04091","pcpfaxno":2076257820,"pcpnpi":1922649417,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8G31G42KJ09","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I5030","G4733","M5416","E119","R799","I10","E785","H539","R292","S42292A","E876","Z6821","I2510","G47419","S42292D","R600","D229","S42351A","Z79899","M542","E8352","R5383","I083","I5032","H538","B351","I110","M25571","M5431","Z6825","M25579","M48061","R609","R011","M5450","E1169","E1142","G47411","K5900","R262","E113292","E1165","L989","Z0100","Z0101","M25421","Z6828","M25512","R519","S42352A","S42202A"],"date":["2025-11-14","2023-11-07","2024-09-30","2025-07-28","2024-12-10","2025-11-14","2024-12-10","2025-11-10","2025-11-10","2022-12-08","2025-04-11","2025-06-10","2025-11-14","2024-08-05","2023-01-19","2025-07-25","2023-11-15","2022-12-08","2025-10-31","2025-05-28","2023-05-24","2023-05-24","2025-09-15","2025-10-31","2025-10-30","2025-05-28","2025-11-05","2023-09-05","2024-05-13","2024-09-24","2023-09-05","2024-02-08","2025-06-27","2025-06-27","2024-09-30","2025-10-22","2023-07-31","2025-07-28","2024-01-22","2024-01-22","2025-11-07","2023-08-23","2025-04-04","2024-12-17","2023-12-05","2022-12-27","2022-12-27","2022-12-07","2023-05-24","2022-11-17","2022-11-17"],"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":[["","","METHYLPHENIDATE HCL","","","Select","Select",""],["","","PRAMIPEXOLE DIHYDROCHLORIDE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","DEXCOM G7 RECEIVER","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","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":""}]}]}