{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Joy A Burgess","gend":1,"currentgend":"","add":"154 DRESDEN AVE","city":"Gardiner","state":"ME","zip":"04345","dob":"1941-10-14","age":"","mstatus":"","insh":"10000035025","cliId":"","pno":2074952591,"cno":"","email":"noemail@02152025.com","ename":"","eno":"","pphy":"MADDEN, AMY K","ppno":2076261561,"pcpadd":"PO BOX 274,","pcpcity":"BELGRADE","pcpstate":"ME","pcpzip":"04917","pcpcounty":"","pcpid":"","pcpname":"BELGRADE REGIONAL HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"832 WEBBER POND RD","madd2":"","madd3":"","mcity":"Vassalboro","mstate":"ME","mzip":"04989","pcpfaxno":2074953353,"pcpnpi":1508975152,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7D14NV1UX70","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R410","F0390","Z743","M810","Z780","S0101XA","W19XXXA","N390","M25512","M25511","R197","Z5181","K0889","Y92128","S0990XA","R9089","B029","M25551","F0392","R451","Z79899","M542","R519","R0789","M12811","B351","M79674","M79675","I70293","S199XXA","M8580","M47812","M546","F03911","F418","W1849XA","S79911A","Y939","M19012","R109","R140","G8929","W010XXA","Y92129","E538","E782","H61892","H9192","H9202","H73892","Z7189","Z0000","K5900","S7001XA","L602","I951","R296","R5381","R079","K7689","R918","I728","Z13820","H353131","Z0101","M19011","G319","K529","S299XXA","K449","S0003XA","W06XXXA","H9193","R030","H26499","H524","F4329","R9389","I517","H9212","F22","I672","H539","I771","Z23"],"date":["2025-09-25","2025-09-25","2025-09-25","2023-06-20","2023-03-29","2025-09-29","2025-10-30","2025-10-30","2025-09-24","2023-10-16","2025-04-21","2024-11-08","2025-05-19","2025-10-30","2024-06-17","2024-02-07","2024-11-21","2025-04-22","2024-09-05","2024-09-05","2025-06-09","2025-09-25","2025-09-25","2024-06-26","2023-01-13","2024-07-26","2024-07-26","2024-07-26","2024-07-26","2024-06-17","2024-06-17","2024-06-17","2024-06-17","2025-01-02","2025-06-09","2024-06-17","2025-10-30","2025-09-24","2024-02-10","2025-06-09","2025-06-09","2024-06-20","2024-06-20","2024-06-20","2023-03-01","2023-03-01","2024-01-11","2024-01-11","2024-01-11","2024-01-11","2023-07-18","2023-03-01","2025-06-18","2025-10-30","2024-04-30","2025-06-12","2025-07-21","2025-07-21","2024-06-26","2024-06-17","2024-02-07","2024-06-17","2023-03-29","2023-06-01","2023-06-01","2022-12-02","2024-06-17","2025-06-18","2024-06-17","2024-06-17","2023-09-08","2023-09-08","2024-01-04","2024-01-04","2023-02-08","2023-02-08","2023-01-18","2024-06-26","2024-06-26","2023-12-21","2024-08-22","2022-11-10","2022-11-10","2022-11-10","2022-10-24"],"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":[["","","SERTRALINE HCL","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","NYSTOP","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","RISPERIDONE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","CITALOPRAM HBR","","","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":""}]}]}