{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ann R Amero","gend":1,"currentgend":"","add":"29 AMERO LANE","city":"OLD TOWN","state":"ME","zip":"04468","dob":"1949-10-25","age":"","mstatus":"","insh":"10000049359","cliId":"","pno":2073942671,"cno":"","email":"declined@100724.com","ename":"","eno":"","pphy":"ROBERTS, CHARLES A","ppno":2078276128,"pcpadd":"PO Box 1599,","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04402","pcpcounty":"","pcpid":"","pcpname":"HELEN HUNT HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2079494250,"add2":"","add3":"","madd1":"29 AMERO LANE","madd2":"","madd3":"","mcity":"OLD TOWN","mstate":"ME","mzip":"04468","pcpfaxno":2078276605,"pcpnpi":1295884716,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1WW4YC0MQ68","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H6123","Z1231","I77819","T1512XA","E039","R17","M9903","M5450","M9904","H903","R6889","H1032","R030","T1592XA","H40013","H5203","H52223","H524","Z09","Z96652","I10","E559","M8580","E7800","Z131","I517","Z952","I350","D3131","H25013","Z0000","M79642","E785","Z1501","Z803","Z953"],"date":["2024-12-05","2024-09-06","2025-03-12","2025-06-10","2025-04-21","2025-04-21","2024-07-08","2024-07-08","2024-07-08","2024-12-17","2023-01-04","2025-06-07","2025-06-07","2025-06-07","2025-10-08","2025-10-08","2025-10-08","2025-10-08","2023-08-31","2023-08-31","2024-03-15","2025-03-10","2025-03-10","2025-03-10","2025-03-10","2025-03-12","2025-03-12","2023-03-20","2025-10-08","2025-10-08","2025-03-17","2022-11-15","2022-11-11","2022-10-14","2022-10-14","2022-08-09"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","NP THYROID","","","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":""}]}]}