{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Barbara G Whitney","gend":1,"currentgend":"","add":"23 BURWICK ST","city":"PORTLAND","state":"ME","zip":"04103","dob":"1936-11-30","age":"","mstatus":"","insh":"10000031902","cliId":"","pno":2073546857,"cno":"","email":"bgwhit@twc.com","ename":"","eno":"","pphy":"MOHAN, ELIZABETH A","ppno":"","pcpadd":"100 GANNETT DR STE C,","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41065900","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"23 BURWICK ST","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04103","pcpfaxno":"","pcpnpi":1952622151,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3WG4MH5FY73","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H6123","M5450","E210","I160","R791","L820","L570","L578","L821","R7989","N179","M546","I10","J449","R0781","Z23","M810","E8352","N1832","K5904","Z0001","N184","H903","D34","E559","R7301","R0602","S0181XA","Z13220","Z87442","R5382","E790","N189","E213","Z515","Z7189","I129","Z8616","R4182","M10072","R0609","N200","G629","D351","M8589","E041","S022XXA","Z8639","R0600","Z87891","S199XXA","S0990XA","H6122","Z461","H6992","E538","Z0100","Z1231","R7303"],"date":["2025-06-30","2023-12-12","2025-04-22","2023-09-13","2025-05-13","2024-01-04","2024-01-04","2024-01-04","2024-01-04","2025-05-13","2024-02-29","2023-12-12","2025-10-16","2024-05-24","2024-05-24","2024-09-13","2025-07-15","2023-07-10","2025-04-22","2023-02-22","2025-10-16","2025-10-14","2025-03-03","2023-02-15","2023-09-13","2022-12-14","2025-04-26","2023-02-27","2025-10-16","2023-08-22","2025-10-16","2025-10-16","2025-10-16","2023-03-30","2025-10-14","2025-10-14","2023-03-30","2023-03-30","2023-03-30","2025-04-28","2025-10-02","2023-08-22","2025-10-16","2023-02-15","2025-03-10","2024-05-15","2023-03-08","2023-11-01","2025-04-25","2025-04-25","2023-02-27","2023-02-27","2024-04-12","2023-02-09","2024-12-31","2022-10-17","2022-04-26","2022-03-21","2022-01-04"],"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":[["","","PREDNISONE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","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":""}]}]}