{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dana G Moody","gend":0,"currentgend":"","add":"20 SPENCER LN","city":"EDDINGTON","state":"ME","zip":"04428","dob":"1953-05-19","age":"","mstatus":"","insh":"10000066566","cliId":"","pno":2073234855,"cno":2073234855,"email":"","ename":"","eno":"","pphy":"STEPP, BENJAMIN N","ppno":2074048181,"pcpadd":"Penobscot Community Health Center,992 Union St Ste J","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"ADULT WELLNESS CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 488","madd2":"","madd3":"","mcity":"HOLDEN","mstate":"ME","mzip":"04429","pcpfaxno":"","pcpnpi":1013237536,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2WY9EF2YN18","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I6930","H53462","H53461","N1831","I10","N200","N1330","K449","I618","I619","Z87891","I4720","Z125","R209","M79621","E119","Z87442","N400","N2889","R82998","Z09","Z8673","Z7982","G9389","E559","D649","T50905A","R7303","R42","I129","N281","M79604","N1832","H578A1","T1511XA","R930","I639","N132","Z0100","N401","I6389","R339","N189","I629","R338","K061","R011","I609","R410","N138","Z79899","I6523","N3090","R6889","I69398","I611","Z0000","N320","E8881","Z7689","R7309","R5383","E7800","M25551","U071"],"date":["2024-10-22","2024-10-22","2024-10-22","2024-12-30","2025-10-07","2025-10-21","2024-05-16","2023-07-25","2024-12-30","2025-02-25","2024-09-30","2025-01-13","2023-04-24","2023-11-27","2023-11-27","2024-06-13","2023-09-28","2023-09-28","2023-09-28","2023-09-28","2025-06-03","2025-06-03","2025-02-14","2025-03-06","2025-01-17","2024-12-30","2023-08-27","2025-03-11","2025-03-11","2024-08-23","2023-07-06","2023-07-19","2025-01-17","2024-02-28","2024-02-28","2024-11-14","2024-12-12","2023-07-06","2025-04-15","2025-10-21","2025-03-06","2024-09-01","2022-12-19","2024-08-28","2023-07-06","2024-07-11","2024-07-11","2024-08-26","2024-08-26","2025-10-21","2025-10-21","2024-08-28","2023-07-25","2023-06-13","2025-01-07","2024-12-30","2025-01-09","2022-08-25","2022-06-03","2022-04-25","2022-04-25","2022-04-25","2022-04-25","2022-03-31","2022-04-01"],"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":[["","","PRAZOSIN HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE 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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}