{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Diane L Goff","gend":1,"currentgend":"","add":"11 WHEELER RD","city":"GRAY","state":"ME","zip":"04039","dob":"1959-08-29","age":"","mstatus":"","insh":"10000070283","cliId":"","pno":2079395502,"cno":"","email":"","ename":"","eno":"","pphy":"HILARY, MANJU","ppno":2076573308,"pcpadd":"126 SHAKER RD,","pcpcity":"GRAY","pcpstate":"ME","pcpzip":"40399629","pcpcounty":"","pcpid":"","pcpname":"GRAY FAMILY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"11 WHEELER RD","madd2":"","madd3":"","mcity":"GRAY","mstate":"ME","mzip":"04039","pcpfaxno":2076573309,"pcpnpi":1710066410,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4UM4EJ8YW05","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F22","Z0000","F329","Z87891","E785","H40053","S01111A","R3915","R399","U071","R1310","R918","Z96612","R059","R509","Z043","R220","G319","J329","K2080","H401131","H1131","W01198A","R350","Z23","E6601","Z6839","R6889"],"date":["2025-10-14","2023-10-23","2023-10-23","2023-10-23","2023-10-23","2025-09-15","2022-12-22","2023-09-14","2023-09-18","2022-12-04","2023-01-04","2022-12-04","2022-12-04","2022-12-04","2022-12-04","2022-12-04","2022-12-04","2022-12-04","2022-12-04","2023-01-04","2025-02-19","2022-12-04","2022-12-04","2024-06-12","2023-10-18","2022-10-25","2022-10-25","2022-09-19"],"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":[["","","FENOFIBRATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","BENZTROPINE MESYLATE","","","Select","Select",""],["","","HALOPERIDOL","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","SHINGRIX","","","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":""}]}]}