{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia V Ross","gend":1,"currentgend":"","add":"20 GREAT FALLS PLAZA APT 317","city":"Auburn","state":"ME","zip":"04210","dob":"1942-03-30","age":"","mstatus":"","insh":"10000055803","cliId":"","pno":2072125850,"cno":"","email":"patpatross@yahoo.com","ename":"","eno":"","pphy":"PICKER, BETHANY J","ppno":2077952800,"pcpadd":"272 CONGRESS ST,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41013637","pcpcounty":"","pcpid":"","pcpname":"CMMC FAMILY MEDICINE RESIDENCY PROGRAM","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"20 GREAT FALLS PLAZA APT 317","madd2":"","madd3":"","mcity":"Auburn","mstate":"ME","mzip":"04210","pcpfaxno":2077744625,"pcpnpi":1407952468,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9R05UW0EW95","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R599","Z5111","L309","Z9013","M25551","C50919","K5730","K429","C50911","Z79818","C773","Z170","C969","Z17411","Z853","H43393","N1830","R911","R590","M85852","Z780","Z87891","M8580","H903","H9313","Z0101","M25559","M25552","L821","L814","K760","D734","C761","R609","K5790","R5383","Z79811","E669","L905","Z0000","E785","I10","H6123","Z13820","M160","M47816","D225","Z923","R42","M9900","M9901","M9902"],"date":["2023-10-25","2025-11-11","2023-08-24","2025-09-09","2024-02-06","2024-11-18","2024-11-18","2024-11-18","2025-05-28","2025-03-05","2025-05-28","2024-09-18","2023-09-18","2025-05-28","2025-05-16","2024-02-09","2023-04-04","2023-08-26","2023-09-18","2023-04-11","2025-09-18","2023-08-26","2025-05-28","2024-03-05","2024-03-05","2025-02-11","2023-04-18","2023-04-18","2024-10-03","2024-10-03","2023-11-18","2023-11-18","2023-09-29","2023-09-29","2023-09-29","2023-08-02","2023-11-08","2023-03-28","2023-10-25","2023-03-24","2023-03-24","2023-03-24","2023-10-05","2025-09-18","2023-04-18","2023-04-18","2024-05-29","2023-11-21","2022-11-11","2022-11-11","2022-11-11","2022-11-11"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","ANASTROZOLE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","ONDANSETRON HCL","","","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":""}]}]}