{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dana R Melville","gend":0,"currentgend":"","add":"1024 RIVER AVE","city":"Gardiner","state":"ME","zip":"04345","dob":"1954-06-05","age":"","mstatus":"","insh":"10000068878","cliId":"","pno":2075824281,"cno":"","email":"declined@09292025.com","ename":"","eno":"","pphy":"HACKETT, MELISSA C","ppno":2077374359,"pcpadd":"Richmond Area Health Center,24 Gardiner St","pcpcity":"Richmond","pcpstate":"ME","pcpzip":"04357","pcpcounty":"","pcpid":"","pcpname":"RICHMOND AREA HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1024 RIVER AVE","madd2":"","madd3":"","mcity":"Gardiner","mstate":"ME","mzip":"04345","pcpfaxno":2077374412,"pcpnpi":1902170392,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8HK9DW1GN27","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H35371","Z0100","R9082","H33312","S066X0D","S065X0D","I609","V199XXA","R55","H43813","S2249XD","S199XXA","M47812","M50322","S020XXA","S0240FA","S02109A","H25811","L989","I10","I6523","H25812","H4312","H35032","H33322","S066X9A","T07XXXA","Z0000","S2242XA","S7002XA","H25813","Z9849","R6889","S0990XD","J939","R519","W19XXXA","Z23","S2232XA","S59902A","S3991XA","S3993XA","S270XXA","R4182","S066X0A","S0990XA","H40003"],"date":["2025-10-16","2025-10-16","2024-06-11","2024-12-31","2024-04-25","2024-04-25","2024-06-11","2024-04-23","2024-04-23","2024-12-31","2024-05-09","2024-04-23","2024-04-23","2024-04-23","2024-04-23","2024-04-23","2024-04-23","2024-12-11","2023-01-11","2025-05-23","2024-04-24","2025-01-08","2023-04-21","2023-04-21","2024-11-08","2024-04-23","2024-05-14","2025-05-23","2024-05-09","2024-05-17","2025-01-08","2025-02-27","2023-12-16","2024-04-30","2024-04-26","2024-04-23","2024-04-23","2023-11-01","2024-04-23","2024-04-23","2024-04-23","2024-04-23","2024-12-11","2025-01-08","2024-04-23","2024-04-23","2024-11-08"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","LEVETIRACETAM","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}