{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sheena L Peillet","gend":1,"currentgend":"","add":"77 MARY CARROLL ST","city":"AUBURN","state":"ME","zip":"04210","dob":"1951-06-16","age":"","mstatus":"","insh":"10000052881","cliId":"","pno":2077824194,"cno":"","email":"shemark@myyahoo.com","ename":"","eno":"","pphy":"RABY, NATHAN C","ppno":2079982100,"pcpadd":"Community Health Center,364 Maine St","pcpcity":"Poland","pcpstate":"ME","pcpzip":"04274","pcpcounty":"","pcpid":"","pcpname":"POLAND COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"77 MARY CARROLL ST","madd2":"","madd3":"","mcity":"AUBURN","mstate":"ME","mzip":"04210","pcpfaxno":"","pcpnpi":1770528143,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6KJ0NJ2KK44","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M542","F419","F449","F444","M5010","M25551","M7061","Z1231","Z0101","G250","M792","H2511","Z0000","Z6827","M25552","F447","Z85828","D229","L570","M7062","Z780","M47812","M4722","M4802","M5000","M4312","M5412","N3001","R3589","L820","B351","M79674","M79675","M25774","C44311","R350","R52","E162","G959","M7910","M62831","N3090","M8589","T148XXA","R202","M5030","D649","M71371","D492","R410","R531","M25511","F341","F688","R29898","M79661","M79662","M25512","R200"],"date":["2025-05-02","2025-10-28","2025-10-28","2025-11-19","2025-01-07","2025-11-19","2025-11-19","2025-05-22","2023-10-24","2025-05-07","2025-10-28","2025-02-27","2025-03-26","2023-03-08","2025-10-20","2025-07-08","2025-05-29","2025-05-29","2025-05-29","2025-06-18","2025-05-22","2025-02-14","2025-01-22","2025-02-14","2025-02-19","2025-02-19","2024-12-05","2025-08-01","2025-08-01","2024-04-08","2025-06-05","2025-06-05","2025-06-05","2025-06-05","2023-02-07","2025-08-01","2024-11-15","2025-08-04","2025-02-14","2025-02-13","2025-02-13","2025-08-04","2025-05-22","2025-10-28","2024-10-23","2024-10-28","2024-02-14","2024-05-14","2022-10-26","2022-10-07","2022-10-07","2022-10-03","2022-09-09","2022-09-22","2022-09-22","2022-09-01","2022-09-01","2022-09-01","2022-09-01"],"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":[["","","LORAZEPAM","","","Select","Select",""],["","","CARBIDOPA-LEVODOPA","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","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":""}]}]}