{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carolyn L Bailey","gend":1,"currentgend":"","add":"864 NEW DUNN TOWN RD","city":"Washburn","state":"ME","zip":"04786","dob":"1945-10-09","age":"","mstatus":"","insh":"10000052614","cliId":"","pno":2074558413,"cno":"","email":"declined@030723.com","ename":"","eno":"","pphy":"ST PETER, DAYNA","ppno":2074982356,"pcpadd":"Pines Health Services,74 Access Hwy","pcpcity":"Caribou","pcpstate":"ME","pcpzip":"04736","pcpcounty":"","pcpid":"","pcpname":"PINES CARIBOU HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 73","madd2":"","madd3":"","mcity":"Washburn","mstate":"ME","mzip":"04786","pcpfaxno":2074937725,"pcpnpi":1760014856,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1QW9R78CD10","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R109","R519","R9089","C4401","L570","L821","Z7189","Z08","L820","L538","R440","F419","Z739","I10","Z1211","Z86010","Q438","K648","R6889","R1010","R0981","H538","R053","R42","M25511","M25561","M25571","D1801","D485","R208","Z87891","Z1152","Z1212","I6782","M19011","D225","L814","M24011","M7541","M25811","R4181","H2513","M19041","M67441","M180","M19042","L989","Z85828","Z0000","F410","F430","E785","N393"],"date":["2024-01-29","2024-01-24","2024-01-24","2024-04-03","2025-03-04","2025-03-04","2025-03-04","2024-02-01","2024-04-03","2024-04-03","2024-12-09","2023-04-29","2025-03-01","2024-06-27","2023-07-07","2023-07-07","2023-07-07","2023-07-07","2025-08-01","2024-02-09","2023-04-10","2023-04-29","2024-12-02","2023-05-19","2024-03-14","2022-12-14","2022-12-14","2024-04-03","2024-04-03","2024-04-03","2023-11-17","2023-04-04","2023-04-04","2023-11-17","2024-05-02","2025-03-04","2025-03-04","2024-03-14","2024-03-14","2024-03-14","2023-04-24","2023-06-08","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-09-28","2022-09-28","2022-08-25","2022-08-25","2022-08-25","2022-08-25","2022-08-22"],"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":""}]}]}