{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy J Hachey","gend":1,"currentgend":"","add":"12 PRIVATE DR","city":"Winslow","state":"ME","zip":"04901","dob":"1949-05-15","age":"","mstatus":"","insh":"10000033742","cliId":"","pno":2076160389,"cno":"","email":"nh49@hotmail.com","ename":"","eno":"","pphy":"POLONCHEK, KATHLEEN D","ppno":2074533100,"pcpadd":"Four Seasons Family Practice,4 Sheridan Rd Ste 2","pcpcity":"Fairfield","pcpstate":"ME","pcpzip":"04937","pcpcounty":"","pcpid":"","pcpname":"FOUR SEASONS FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"12 PRIVATE DR","madd2":"","madd3":"","mcity":"Winslow","mstate":"ME","mzip":"04901","pcpfaxno":2074533082,"pcpnpi":1659784064,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7HD3DE4YP72","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M48061","M5416","Z23","M1711","N1832","Z0000","M5410","M25561","Z96652","J111","J9801","R5383","M5126","R609","Z1231","M47816","M47817","Z98890","M549","M5136","I129","Z131","Z4789","Z981","M5450","Z471","Z96651","I10","Z7189","Z66","L918","M21061","M19011","M19012","M4187","G9741","Y848","R6889","F32A","G8918","E785","E559","Z0100","M25461","M5116","M4726","M4727"],"date":["2025-10-10","2023-10-18","2025-10-02","2024-04-23","2025-09-26","2025-04-09","2023-08-09","2024-04-22","2024-03-26","2022-12-10","2022-12-10","2022-12-10","2024-03-06","2023-07-27","2025-05-06","2025-08-29","2025-08-29","2025-08-29","2024-03-06","2024-03-06","2025-09-25","2025-09-25","2024-11-14","2025-10-10","2025-08-29","2024-05-15","2024-04-22","2025-03-14","2024-10-28","2024-10-28","2023-02-09","2024-03-26","2023-10-18","2023-10-18","2023-10-18","2023-08-29","2023-08-29","2023-04-27","2024-02-08","2024-04-22","2024-01-04","2024-01-04","2024-07-03","2023-05-09","2025-10-08","2025-10-08","2025-10-08"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","COLESTIPOL HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO 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":""}]}]}