{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"William C Kervin","gend":0,"currentgend":"","add":"976 CALAIS RD","city":"Hodgdon","state":"ME","zip":"04730","dob":"1950-10-01","age":"","mstatus":"","insh":"10000043256","cliId":"","pno":2075323154,"cno":"","email":"","ename":"","eno":"","pphy":"THOMAS, CHRISTINE L","ppno":2075322234,"pcpadd":"PO BOX 40,","pcpcity":"CARIBOU","pcpstate":"ME","pcpzip":"47360040","pcpcounty":"","pcpid":"","pcpname":"SIGRID E TOMPKINS HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"976 CALAIS RD","madd2":"","madd3":"","mcity":"Hodgdon","mstate":"ME","mzip":"04730","pcpfaxno":2074983947,"pcpnpi":1235107848,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6AH6KF4YR50","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C44319","H93A3","D225","L821","L814","Z7189","L570","L03114","Z09","Z1211","D125","Z0000","Z01818","K6289","R6889","H903","H353131","D485","H9313","H6123","K5731","I358","K5730","H93A9"],"date":["2023-01-12","2023-04-04","2024-10-23","2024-10-23","2024-10-23","2024-10-23","2024-10-23","2024-06-29","2025-01-20","2024-06-13","2024-06-13","2025-01-06","2025-03-03","2025-04-02","2023-04-03","2024-02-05","2024-09-23","2022-11-07","2024-02-05","2024-02-05","2024-04-16","2024-03-26","2024-04-12","2022-09-22"],"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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","BREZTRI AEROSPHERE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","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":""}]}]}