{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Phyllis A Savage","gend":1,"currentgend":"","add":"24 PARKER HILL RD","city":"GORHAM","state":"ME","zip":"04038","dob":"1953-04-26","age":"","mstatus":"","insh":"10000066732","cliId":"","pno":2078385719,"cno":"","email":"phyllissavage53@gmail.com","ename":"","eno":"","pphy":"BOBZIEN, ELIZABETH R","ppno":2078741489,"pcpadd":"100 GANNETT DRIVE,SUITE C","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"24 PARKER HILL RD","madd2":"","madd3":"","mcity":"GORHAM","mstate":"ME","mzip":"04038","pcpfaxno":2075238590,"pcpnpi":1144549320,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9YA9RW3MD11","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H47232","E039","Z139","M961","M8580","E782","M25512","L649","M50321","M47812","M47816","M25552","Z0001","H903","R6889","I700","M069","G500","Z79899","M7502","M8588","H6121","M25551","M5416","R911","Z801","M9900","M5412","M9901","M542","G44201","M9902","M9904","H16223","H1132","M531","Z23","H469","M150","Z1231","M5450","M47817","G8929","F419","M60811","M25511","M50122","M19011","H6123","M5451","M9903","M5414","R208","M4316","G894","S29012A"],"date":["2023-02-09","2025-09-22","2024-05-28","2023-06-27","2025-06-23","2025-06-23","2024-12-07","2025-05-12","2023-05-25","2023-05-25","2023-05-25","2023-05-25","2025-06-18","2023-02-15","2023-05-09","2025-06-23","2024-12-13","2024-09-11","2024-12-13","2024-12-13","2023-09-20","2023-02-15","2023-05-25","2023-05-25","2023-06-06","2023-06-06","2023-02-15","2023-02-15","2023-02-15","2023-02-15","2023-01-24","2023-01-24","2023-01-24","2023-07-10","2023-07-10","2023-01-03","2023-05-24","2023-05-24","2023-09-18","2024-07-19","2025-06-11","2025-06-11","2024-11-11","2024-09-11","2022-11-07","2022-11-07","2022-08-23","2022-08-23","2022-08-23","2022-05-02","2022-05-02","2022-04-20","2022-03-01","2022-03-01","2022-01-18","2022-01-18"],"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":[["","","VALACYCLOVIR","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","SYNTHROID","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","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":[]}},{"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":""}]}]}