{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dennis A Kosciusko","gend":0,"currentgend":"","add":"40 KOSCIUSKO DR","city":"STETSON","state":"ME","zip":"04488","dob":"1942-10-15","age":"","mstatus":"","insh":"10000076015","cliId":"","pno":2072962952,"cno":"","email":"DECLINED@05282024.COM","ename":"","eno":"","pphy":"STEPP, BENJAMIN N","ppno":"","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":"40 KOSCIUSKO DR","madd2":"","madd3":"","mcity":"STETSON","mstate":"ME","mzip":"04488","pcpfaxno":"","pcpnpi":1013237536,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4AT4HP3PD05","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R42","D485","U071","J8410","R509","R059","R197","Z0100","S2096XA","W57XXXA","L570","L821","L814","D225","Z08","R1310","Z8589","I480","L218","C4441","I4891","L820","L538","R208","L2089","C44619","I081","H9201","R29818","R4182","R194","J189","E871","Z1152","I639","J929","S0501XA","Y93H2","R110","I959","D649","R531","H6121","D6869","I10","I739","I951","I119","R5383","D224","R112","L818","K5790","H02831","H02834","H43813","I4819","E039"],"date":["2025-01-14","2025-01-30","2024-03-19","2024-03-19","2024-03-20","2024-03-19","2024-04-25","2025-08-06","2025-03-12","2025-03-12","2023-03-27","2025-01-30","2025-01-30","2025-01-30","2024-08-01","2024-12-11","2024-10-07","2024-09-11","2023-07-25","2025-03-05","2024-09-30","2024-01-23","2024-01-23","2024-01-23","2025-01-30","2023-01-24","2025-01-10","2025-06-12","2023-08-31","2024-03-20","2023-10-03","2024-03-20","2024-09-11","2024-03-20","2023-07-28","2023-07-27","2024-05-10","2024-05-10","2024-06-17","2024-09-11","2024-09-11","2024-03-20","2025-01-21","2024-09-30","2024-09-30","2024-09-30","2023-07-28","2023-07-28","2024-04-25","2023-03-27","2025-01-09","2022-11-22","2022-09-21","2022-07-20","2022-07-20","2022-07-20","2022-07-05","2022-07-06"],"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":[]},{"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":""}]}]}