{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sherry A Benway","gend":1,"currentgend":"","add":"41 WESTRIDGE DR","city":"HERMON","state":"ME","zip":"04401","dob":"1960-02-09","age":"","mstatus":"","insh":"10000046902","cliId":"","pno":2073566440,"cno":"","email":"tsbenway@gmail.com","ename":"","eno":"","pphy":"Collins, Amanda S","ppno":2079412373,"pcpadd":"EMMC HUSSON FAMILY MEDICINE,302 HUSSON AVE STE 2","pcpcity":"BANGOR","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HUSSON FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"41 WESTRIDGE DR","madd2":"","madd3":"","mcity":"HERMON","mstate":"ME","mzip":"04401","pcpfaxno":2079418803,"pcpnpi":1881960458,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3RJ3HC8ND80","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M533","M170","M47817","N6342","F411","F330","I493","M47816","N6489","R921","E782","R002","R5383","M797","R6889","I498","M5450","Z7982","E236","Z0001","G629","I340","M1612","M25552","S82234A","S82001A","G43809","M11262","M11261","S8981XA","Z0000","R0781","S83281A","S8011XA","M1711","X58XXXA","R0789","F5105","Z791","Z79899","Z13820","R61","R920","M7910","U071","M9901","M9902","M9903","M9904","Z1231","R059","M5417","N6012","S83271A","S83231A","W19XXXA","M25561","M25562","R748","E669","Z780","M1712","M25572","M76822","M216X2","L03011","R21","Z7182","M79672","Z0101","H524"],"date":["2024-04-03","2024-12-16","2024-01-24","2024-01-05","2023-12-06","2023-12-06","2024-05-06","2024-01-24","2025-04-07","2024-01-05","2025-03-05","2023-12-15","2023-05-31","2023-11-17","2023-12-23","2022-11-10","2024-04-03","2023-08-11","2023-07-25","2025-05-01","2025-03-19","2022-12-08","2023-09-05","2023-09-05","2022-12-06","2022-12-06","2022-11-29","2022-11-28","2022-11-28","2022-11-28","2024-04-24","2024-11-01","2022-12-14","2022-12-14","2023-01-03","2022-12-14","2023-05-23","2024-03-28","2023-10-19","2023-10-19","2025-03-20","2022-10-18","2025-04-07","2024-04-03","2025-01-21","2024-04-03","2024-04-03","2024-04-03","2024-04-03","2023-04-19","2025-01-21","2025-03-19","2023-04-21","2023-01-17","2023-01-17","2023-01-17","2023-10-18","2023-10-18","2024-05-06","2023-01-19","2025-03-20","2023-01-03","2022-08-09","2022-08-09","2022-08-09","2024-05-06","2024-05-06","2022-06-16","2022-06-16","2022-06-14","2022-06-14"],"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":[["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y 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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}