{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Evelyn Jean","gend":1,"currentgend":"","add":"550 College Apt 103","city":"Lewiston","state":"ME","zip":"04240","dob":"1935-04-21","age":"","mstatus":"","insh":"10000052217","cliId":"","pno":2073125396,"cno":"","email":"","ename":"","eno":"","pphy":"Bethany J Picker","ppno":2077952800,"pcpadd":"76 High St,","pcpcity":"Lewiston","pcpstate":"ME","pcpzip":"42407649","pcpcounty":"","pcpid":"","pcpname":"Cmmc Family Medicine Residency Program","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"550 College Apt 103","madd2":"","madd3":"","mcity":"Lewiston","mstate":"ME","mzip":"04240","pcpfaxno":2077952808,"pcpnpi":1407952468,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3ER7NA9EY71","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B0229","R1012","R55","B0223","Z739","I110","G4700","Z79899","D649","R0602","B029","R0789","R21","M533","S72002A","I10","M79604","M79605","R918","R079","R9089","I4891","M069","R627","I080","I77810","G9340","N179","I509","I480","R7989","I214","R109","M546","D509","E874","M059","M1711","M1611","I4820","M79651","R002","M25559","G2581","N3281","J810","R1110","M1990","M79606","M8580","E538","E559","I5189","W1830XA","R011","N390","B351","M79675","M79674","R197","E871","I38","Z20822","Z7901","M25462","R110","S6991XA","S6992XA","S8992XA","I5032","S0990XA","S199XXA","S79912A","Z043","M50322","M47812","R221","R9431","I2510","E46","R2681","R001"],"date":["2024-08-05","2024-11-15","2025-07-07","2025-07-07","2025-03-01","2025-04-09","2024-07-17","2023-11-16","2024-10-03","2024-11-09","2024-07-31","2024-11-09","2024-08-03","2022-11-03","2022-11-03","2025-04-09","2025-04-10","2025-04-10","2022-11-02","2024-11-24","2022-11-02","2023-11-07","2023-10-24","2024-08-05","2024-08-05","2024-08-05","2025-04-16","2025-05-15","2025-04-18","2024-10-08","2025-04-10","2025-04-10","2024-11-20","2024-08-13","2024-09-25","2025-04-16","2024-09-10","2024-04-04","2024-04-05","2025-05-01","2024-04-04","2023-11-16","2025-04-09","2024-03-15","2024-03-15","2024-11-09","2024-03-17","2023-10-05","2024-04-04","2023-07-31","2023-07-31","2023-07-31","2022-11-04","2022-11-03","2023-10-12","2024-03-17","2025-02-12","2025-02-12","2025-02-12","2024-03-17","2024-03-17","2022-12-16","2022-11-02","2022-11-02","2025-04-10","2024-11-15","2025-04-09","2025-04-09","2025-04-09","2025-05-15","2025-04-09","2025-04-09","2025-04-09","2022-11-03","2022-11-03","2022-11-03","2022-11-03","2022-11-02","2022-12-16","2024-09-25","2024-10-04","2022-12-16"],"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":[]},{"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":""}]}]}