{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John K Elberfeld","gend":0,"currentgend":"","add":"49 SPRING BROOK DRIVE","city":"BELFAST","state":"ME","zip":"04915","dob":"1945-02-20","age":"","mstatus":"","insh":"10000045466","cliId":"","pno":2072181263,"cno":2079305927,"email":"","ename":"","eno":"","pphy":"FINLEY, MONICA","ppno":2073386900,"pcpadd":"PO BOX 1599,PENOBSCOT COMMUNITY HEALTH CENTER","pcpcity":"BANGOR","pcpstate":"ME","pcpzip":"44021599","pcpcounty":"","pcpid":"","pcpname":"SEAPORT COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"49 SPRING BROOK DRIVE","madd2":"","madd3":"","mcity":"BELFAST","mstate":"ME","mzip":"04915","pcpfaxno":"","pcpnpi":1104176478,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6Y70EA5UN16","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C20","H40013","M19071","M7989","M79672","Z008","M19072","M2041","M2042","H9190","Z6827","M1A9XX0","B351","R197","C189","K921","R194","R159","H903","H9313","R42","Z0101","H25813","H353121","H9121","R6889","R152","Z461","K648","R143","M25562","M1712","M25561","M1711","Z23","R2242","R609","M10072","M7732","K529","R140","Z09","K635","E790","K621","K638219","M722","M65272","K649","N1830","Z125","I3489","Z0000","F325","E663","G4700","H9193"],"date":["2025-03-20","2025-03-06","2024-07-24","2024-07-24","2024-07-24","2023-07-03","2024-07-24","2024-07-24","2024-07-24","2024-02-19","2024-05-10","2024-05-10","2024-05-10","2024-11-22","2025-05-27","2025-03-20","2025-03-20","2025-03-20","2025-05-14","2025-03-14","2025-03-14","2025-02-18","2025-02-18","2024-02-06","2024-02-29","2023-01-01","2024-09-30","2023-11-27","2024-09-30","2024-09-30","2025-11-06","2025-11-06","2025-11-06","2025-11-06","2025-11-06","2024-06-21","2024-10-09","2024-06-21","2024-06-21","2025-02-11","2024-11-22","2025-06-12","2025-06-12","2025-11-06","2025-06-12","2025-02-11","2023-05-15","2024-06-28","2024-07-22","2025-11-06","2025-11-06","2024-10-09","2025-11-06","2022-10-24","2022-10-24","2022-10-24","2022-09-08"],"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":[["","","ALLOPURINOL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","GAVILYTE-N","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","DIPHENOXYLATE-ATROPINE","","","Select","Select",""],["","","CHOLESTYRAMINE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","ABRYSVO","","","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":""}]}]}