{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jane E Poulin","gend":1,"currentgend":"","add":"1112 BECKWITH RD","city":"Cornville","state":"ME","zip":"04976","dob":"1949-09-08","age":"","mstatus":"","insh":"10000035582","cliId":"","pno":2074745030,"cno":"","email":"janepoulin1949@gmail.com","ename":"","eno":"","pphy":"DICRANIAN, WENDY R","ppno":2078584844,"pcpadd":"PO BOX 468,","pcpcity":"SKOWHEGAN","pcpstate":"ME","pcpzip":"49760468","pcpcounty":"","pcpid":"","pcpname":"SOMERSET PRIMARY CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1112 BECKWITH RD","madd2":"","madd3":"","mcity":"Cornville","mstate":"ME","mzip":"04976","pcpfaxno":2078580348,"pcpnpi":1447287883,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7W37P56JT65","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E785","L570","L814","L821","D225","Z7189","D1801","C4441","R9389","Z0000","Z1231","L905","Z87891","I10","Z0100","M5116","C44619","M9904","M9905","M9903","M5136","R0989","C4442","D485","R059","Z122","J432","F17200","F17210","E8352","R200","Z08","M5450","J449","M19041","M85852"],"date":["2024-03-15","2025-10-07","2025-10-07","2025-10-07","2025-10-07","2024-10-18","2025-10-07","2024-02-09","2024-06-06","2025-02-12","2025-06-25","2024-07-16","2023-04-21","2024-03-15","2024-04-25","2024-09-04","2024-07-16","2024-05-21","2024-05-21","2024-05-21","2024-05-21","2024-02-07","2024-06-05","2025-10-07","2023-10-19","2025-04-23","2024-04-22","2023-04-21","2023-04-21","2025-02-27","2024-02-07","2025-10-07","2024-09-04","2024-03-15","2024-03-15","2022-06-20"],"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":[["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","CALCIPOTRIENE","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y 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":""}]}]}