{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sybil S Townsend","gend":1,"currentgend":"","add":"25 SAND POINT LN","city":"CUMBERLAND FORESIDE","state":"ME","zip":"04110","dob":"1939-01-01","age":"","mstatus":"","insh":"10000045720","cliId":"","pno":2072635546,"cno":"","email":"sybiesyb@gmail.com","ename":"","eno":"","pphy":"MOHAN, ELIZABETH A","ppno":"","pcpadd":"100 GANNETT DR STE C,","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41065900","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"25 SAND POINT LN","madd2":"","madd3":"","mcity":"CUMBERLAND FORESIDE","mstate":"ME","mzip":"04110","pcpfaxno":"","pcpnpi":1952622151,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7KX1CX5YJ24","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K449","K222","K225","K3189","Z23","K219","R1310","C44212","D2261","F418","R1319","Z0000","Q396","H6121","H903","L308","T8130XA","L578","L821","Z0101","H353131","H35373","R7303","H906","L989","M8580","T18120A","Z538","K224","I10","R4182","H918X3","D485","T18128A","R21","D225","H6122","Z0001","Z48815","R918","K2090","R7989","Z7189","M8588","R6889","J90","J811","S40862A","W57XXXA","H353121","H43813"],"date":["2025-08-27","2025-01-08","2025-08-18","2024-05-22","2025-09-18","2025-06-12","2025-08-18","2025-02-12","2025-05-06","2024-07-31","2025-08-19","2023-08-30","2025-08-19","2023-08-30","2025-06-03","2023-12-14","2023-12-14","2025-05-06","2025-05-06","2025-06-30","2025-06-30","2025-07-21","2025-10-27","2025-08-12","2023-11-28","2025-10-27","2024-12-18","2024-12-18","2025-01-08","2025-01-08","2025-08-18","2025-06-03","2025-05-06","2024-12-18","2023-09-15","2025-05-06","2024-12-03","2025-11-04","2025-08-19","2025-08-19","2025-08-18","2025-02-04","2024-11-01","2023-09-01","2023-06-15","2025-08-27","2025-08-18","2022-09-21","2022-09-21","2022-06-02","2022-06-02"],"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":[["","","OXYCODONE HCL","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","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":""}]}]}