{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"James A Dudley","gend":0,"currentgend":"","add":"56 ELM ST","city":"Brewer","state":"ME","zip":"04412","dob":"1953-12-22","age":"","mstatus":"","insh":"10000057446","cliId":"","pno":2074618582,"cno":2077260908,"email":"","ename":"","eno":"","pphy":"MUNRO, SHANNON C","ppno":2074548233,"pcpadd":"CCH Internal Medicine,37 Palmer St Ste 2","pcpcity":"Calais","pcpstate":"ME","pcpzip":"04619","pcpcounty":"","pcpid":"","pcpname":"CCH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"56 ELM ST","madd2":"","madd3":"","mcity":"Brewer","mstate":"ME","mzip":"04412","pcpfaxno":"","pcpnpi":1295828499,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8VM2CY4TT01","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C50121","E1140","Z471","C50921","R928","N6321","C773","Z170","Z79810","K285","N179","E669","M216X1","L84","Z8631","M216X2","K4020","N281","Z48815","A419","M19072","C779","T50901A","E119","Z794","I10","M7989","F17210","C50021","E1340","E785","D509","K219","E1342","Z125","M96843","C50821","N6489","L7634","R32","S46891A","S46901A","M25521","R0781","F17200","C50929","K635","Z803","Z8052","Z808","M2170"],"date":["2024-12-02","2023-09-22","2025-10-11","2025-06-03","2023-04-18","2023-04-18","2023-04-04","2023-10-18","2023-10-18","2023-01-05","2023-01-05","2023-01-05","2023-01-24","2023-01-24","2023-01-24","2023-01-24","2023-01-05","2023-01-05","2023-01-27","2023-01-05","2025-08-07","2023-10-18","2023-08-04","2023-08-04","2023-08-04","2023-08-04","2025-08-07","2022-10-24","2022-10-10","2022-10-05","2022-07-08","2022-07-08","2022-07-08","2022-07-08","2022-07-08","2021-11-29","2021-12-06","2021-12-14","2021-12-07","2022-01-17","2022-02-12","2022-02-12","2022-02-12","2022-02-12","2022-02-12","2022-02-23","2022-02-23","2022-02-23","2022-02-23","2022-02-23","2022-01-05"],"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":[["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}