{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jean R Hamilton","gend":1,"currentgend":"","add":"12 PORTER RD","city":"FRYEBURG","state":"ME","zip":"04037","dob":"1941-11-24","age":"","mstatus":"","insh":"10000038955","cliId":"","pno":2079352653,"cno":2079352752,"email":"declined@061322.com","ename":"","eno":"","pphy":"MCALLISTER, LISA S","ppno":"","pcpadd":"North Bridgton Family Practice and Walk In Clinic,14 Wyonegonic Rd","pcpcity":"Bridgton","pcpstate":"ME","pcpzip":"04009","pcpcounty":"","pcpid":"","pcpname":"NORTH BRIDGTON FAMILY PRACTICE AND WALK IN CLINIC","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"12 PORTER RD","madd2":"","madd3":"","mcity":"FRYEBURG","mstate":"ME","mzip":"04037","pcpfaxno":2079353632,"pcpnpi":1295998417,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7J59AA7FT47","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R600","S12190D","R609","J40","D509","I480","T07XXXA","S12101A","S2241XD","D45","S2241XA","S2243XD","N898","Z0000","S12101D","S2221XS","M47812","M25512","R059","U071","V877XXA","S8991XA","M542","N1831","I4891","I350","S12121D","S81811A","S199XXA","S3991XA","S3993XA","R519","I10","B379","S12121A","S2221XA","I509","S12100D","I080","Q2112","Z8781","M549"],"date":["2024-10-10","2024-06-16","2024-09-23","2024-09-25","2025-06-06","2024-08-30","2024-06-26","2024-09-12","2024-07-05","2025-03-10","2024-06-18","2024-06-22","2024-07-05","2025-03-11","2024-09-12","2024-06-28","2024-06-17","2025-02-04","2024-09-23","2024-07-15","2024-06-18","2024-06-15","2024-06-15","2024-12-02","2024-12-02","2024-12-02","2024-09-09","2024-06-15","2024-06-15","2024-06-15","2024-06-15","2024-06-15","2025-01-03","2024-07-26","2024-06-15","2024-06-18","2024-10-23","2024-08-01","2024-06-17","2024-06-17","2024-08-01","2022-09-28"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","HYDROXYUREA","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","KLAYESTA","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","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":""}]}]}