{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Beverly J Berry","gend":1,"currentgend":"","add":"8 ROCKY TOP LN","city":"Bridgton","state":"ME","zip":"04009","dob":"1946-11-03","age":"","mstatus":"","insh":"10000043851","cliId":"","pno":2076475452,"cno":"","email":"","ename":"","eno":"","pphy":"MATUSOVICH, CHARLES S","ppno":2078566010,"pcpadd":"North Bridgton Family Practice,14 Wyonegonic Rd","pcpcity":"North Bridgton","pcpstate":"ME","pcpzip":"04057","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":"8 ROCKY TOP LN","madd2":"","madd3":"","mcity":"Bridgton","mstate":"ME","mzip":"04009","pcpfaxno":2078579324,"pcpnpi":1134143514,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7RN5AH6NE72","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R197","F0394","Z45018","I7091","B351","M79674","L602","A4151","I480","I081","R4182","R413","G9389","R9089","R000","Z950","Z751","F0390","I4891","R32","I495","A419","R399","F03911","B342","R109","L03116","G301","F0280","F02C3","R112","K6389","R188","K8020","U071","R6510","R6521","Z23","N281","R509","M79606","K5989","Z0000"],"date":["2024-11-19","2024-09-10","2023-08-16","2025-05-21","2025-05-21","2025-05-21","2025-05-21","2025-08-28","2023-11-22","2023-11-22","2025-09-02","2023-12-26","2023-09-16","2023-09-16","2024-12-03","2025-10-28","2024-11-06","2025-08-30","2025-08-30","2024-10-24","2023-11-06","2025-08-30","2025-08-30","2024-10-25","2024-12-02","2024-11-19","2024-11-29","2024-09-30","2024-09-30","2023-09-16","2024-10-21","2024-10-21","2024-10-21","2024-10-21","2024-11-29","2024-11-29","2025-08-28","2023-10-02","2025-08-28","2025-08-28","2024-11-29","2024-10-22","2022-11-08"],"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":[["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","RIVASTIGMINE","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","MEMANTINE HCL","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO 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":""}]}]}