{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Maurice J Belanger","gend":0,"currentgend":"","add":"37 MYRTLE ST","city":"MANCHESTER","state":"ME","zip":"04351","dob":"1937-09-12","age":"","mstatus":"","insh":"10000038439","cliId":"","pno":2074463929,"cno":"","email":"","ename":"","eno":"","pphy":"MURPHY, ROCHELLE S","ppno":2076243800,"pcpadd":"Winthrop Family Medicine,149 Main St","pcpcity":"Winthrop","pcpstate":"ME","pcpzip":"04364","pcpcounty":"","pcpid":"","pcpname":"WINTHROP FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 85","madd2":"","madd3":"","mcity":"MANCHESTER","mstate":"ME","mzip":"04351","pcpfaxno":2076243845,"pcpnpi":1245585108,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4KT0UA1KN33","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E785","F419","H353221","R059","I080","R42","I10","R55","F32A","Z87891","D649","E559","H40003","I4510","E871","H40002","Z733","H353211","Z0000","M5450","G8929","N401","I4729","S0181XA","S0990XA","S6992XA","M19042","H35371","S61412A","U071","S60112A","X58XXXA","Y990","R519","Z23","S0191XA","L821","L708","L814","L570","X32XXXA","S60111A","D485","H353112","M79644","I4720","I471","W11XXXA","N138","G319","I6529","I499","H1131","H6123","J309","H938X1","M25512"],"date":["2025-07-16","2025-01-13","2025-10-22","2025-06-09","2023-11-08","2025-02-13","2025-10-29","2025-09-09","2025-01-13","2025-10-29","2025-07-09","2025-07-09","2024-05-29","2025-02-14","2025-10-29","2024-02-13","2024-02-05","2024-05-29","2025-07-16","2025-07-16","2023-04-24","2025-01-03","2023-10-03","2025-10-29","2025-10-29","2023-07-04","2023-07-04","2023-02-02","2024-10-23","2022-12-12","2023-07-07","2025-08-14","2023-07-07","2023-08-09","2024-01-12","2025-08-14","2025-01-08","2025-01-08","2025-01-08","2025-05-08","2025-01-08","2023-07-05","2025-01-08","2024-11-12","2023-07-05","2023-06-12","2023-06-12","2025-08-11","2022-12-07","2023-08-04","2023-08-04","2025-06-02","2025-03-25","2024-05-23","2024-05-23","2022-09-19","2022-08-31"],"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":[["","","FLUAD 2025-2026","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PAXLOVID (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":""}]}]}