{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Betty J Marshall","gend":1,"currentgend":"","add":"67 ROBERTS RD","city":"Bowdoin","state":"ME","zip":"04287","dob":"1953-10-14","age":"","mstatus":"","insh":"10000062966","cliId":"","pno":2077513403,"cno":"","email":"","ename":"","eno":"","pphy":"LONGFELLOW, KAREN A","ppno":2075826608,"pcpadd":"44 MATHEWS AVE,","pcpcity":"WATERVILLE","pcpstate":"ME","pcpzip":"49015233","pcpcounty":"","pcpid":"","pcpname":"GARDINER FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"67 ROBERTS RD","madd2":"","madd3":"","mcity":"Bowdoin","mstate":"ME","mzip":"04287","pcpfaxno":"","pcpnpi":1295049187,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6M43PE2DH89","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1990","M25551","M25552","M79669","M6281","M5450","R911","G8929","Z0001","M542","R0602","Z1231","R92333","I6523","I739","Z87891","M9909","M9901","M9900","M9903","M9905","M9908","R0989","R0789","I10","E7800","M25511","Z0101","H5203","H52223","H524","M65341","H1045","H2513","M9902","E039","E785","F17200","M810","M160","M47816","M533","M2170","R29898","H6123","M19011","H6120","M79604","M79605","M79671","M79672","Z122","M19042","M19041","M9906","M9904","R252","R079","Z0000","M7062","M7061","I998","Z23","M79673"],"date":["2024-05-20","2025-02-26","2023-04-04","2023-04-04","2023-05-04","2025-07-21","2025-07-06","2023-03-07","2022-12-13","2024-01-29","2025-02-28","2025-09-23","2025-09-23","2023-02-16","2023-02-16","2025-07-06","2025-05-05","2025-11-05","2025-11-05","2025-07-21","2023-11-06","2025-11-05","2023-02-16","2025-02-28","2025-02-28","2025-02-28","2024-05-20","2025-06-18","2025-06-18","2025-06-18","2025-06-18","2025-09-17","2025-06-18","2025-06-18","2025-11-05","2025-07-21","2024-04-22","2024-04-22","2024-05-14","2024-11-11","2024-11-11","2025-11-05","2025-11-05","2022-12-13","2022-12-13","2024-03-22","2023-01-18","2022-11-28","2022-11-28","2022-11-28","2022-11-28","2024-04-25","2023-09-26","2023-09-26","2023-08-16","2023-05-04","2023-01-18","2024-11-25","2024-03-13","2022-11-08","2022-11-08","2022-09-27","2022-09-27","2022-09-22"],"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":{"comment":"","sub":[["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","EUTHYROX","","","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":{"indx":[["","","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}