{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Diane R Baker","gend":1,"currentgend":"","add":"65 MAPLE RIDGE RD","city":"HARRISON","state":"ME","zip":"04040","dob":"1955-07-27","age":"","mstatus":"","insh":"10000078592","cliId":"","pno":2075834647,"cno":"","email":"declined@10102025.com","ename":"","eno":"","pphy":"BIEBEL, CRAIG J","ppno":2077446444,"pcpadd":"Western Maine Primary Care,8 Pikes Hill Rd","pcpcity":"Norway","pcpstate":"ME","pcpzip":"04268","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY AND INTERNAL MEDIC","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"65 MAPLE RIDGE RD","madd2":"","madd3":"","mcity":"HARRISON","mstate":"ME","mzip":"04040","pcpfaxno":2077436306,"pcpnpi":1366064826,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6TU5G68XF60","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23","E7801","M25559","I10","M1611","E785","E7800","Z471","Z96641","Z0101","Z0000","M25551","Z1231","M8589","E78011","Z98890","R52","M160","F411","Z13820"],"date":["2025-01-15","2025-04-08","2024-04-02","2025-01-15","2024-04-10","2023-07-18","2025-11-06","2025-04-17","2025-04-18","2024-10-30","2025-10-28","2023-09-21","2025-07-31","2024-05-06","2025-11-11","2024-05-15","2023-02-17","2023-02-17","2023-06-21","2024-05-06"],"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":{"comment":"","sub":[["","","NEXLIZET","","","Select","Select",""],["","","REPATHA SURECLICK","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","PRALUENT PEN","","","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":""}]}]}