{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Christine L Shipps","gend":1,"currentgend":"","add":"65 N MAIN ST","city":"STONINGTON","state":"ME","zip":"04681","dob":"1949-04-23","age":"","mstatus":"","insh":"10000061726","cliId":"","pno":2073672690,"cno":"","email":"clshipps23@gmail.com","ename":"","eno":"","pphy":"FUCHS, ROSE M","ppno":2079229102,"pcpadd":"17 FOUNDERS ST,","pcpcity":"PATTEN","pcpstate":"ME","pcpzip":"47653080","pcpcounty":"","pcpid":"","pcpname":"CORNERSTONE FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 3","madd2":"","madd3":"","mcity":"STONINGTON","mstate":"ME","mzip":"04681","pcpfaxno":2079229080,"pcpnpi":1699770222,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3PH0VR2RX23","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M810","R918","E049","H903","R42","H9325","S01511A","S025XXA","R82994","Z13220","H35443","E083513","Z961","Z860100","D122","D125","K640","R102","H8111","Z01419","Z1231","Z124","M7552","L259","Z1211","L821","L814","D225","Z7189","E042","Z0000","M67814","R296","H6691","A6004","L239","K635","Z23","L570","M25512","R8290","R21","J3089","K6389","K5730","E785","R6889","N898","M19032","M25532","S63512D","Z0101","H1045","D3131","F1290","R4189","Z743","D2272","R110","R400","M1812","S63512A","R7309","Z136"],"date":["2025-07-21","2025-07-21","2025-07-21","2023-01-24","2023-01-24","2023-01-24","2024-12-22","2024-12-22","2023-08-31","2023-08-31","2023-06-23","2023-06-23","2024-05-07","2025-02-25","2025-02-25","2025-02-25","2025-02-25","2025-08-28","2023-05-02","2023-04-10","2024-10-08","2023-04-10","2024-04-16","2024-04-16","2025-02-25","2024-10-14","2024-10-14","2024-10-14","2023-09-14","2024-03-12","2024-12-03","2023-09-25","2024-12-22","2025-06-30","2025-06-30","2025-06-30","2025-02-25","2024-12-03","2025-04-15","2023-11-30","2025-03-28","2025-04-02","2023-06-19","2025-02-25","2025-02-25","2024-12-03","2022-01-01","2025-03-12","2022-12-14","2022-12-14","2022-12-14","2024-05-07","2024-05-07","2024-05-07","2022-09-03","2022-09-03","2022-09-03","2022-09-06","2022-09-03","2022-09-03","2022-07-08","2022-07-08","2022-06-13","2022-06-13"],"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":[["","","PREDNISONE","","","Select","Select",""],["","","IMIQUIMOD","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","VALACYCLOVIR","","","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":""}]}]}