{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Joyce R Gracie","gend":1,"currentgend":"","add":"54 HIGH ST","city":"RICHMOND","state":"ME","zip":"04357","dob":"1951-03-22","age":"","mstatus":"","insh":"10000079824","cliId":"","pno":2076562350,"cno":"","email":"graciecatsanddogs@gmail.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":"54 HIGH ST","madd2":"","madd3":"","mcity":"RICHMOND","mstate":"ME","mzip":"04357","pcpfaxno":2077374412,"pcpnpi":1902170392,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9NJ8GU4VM35","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M2061","G5761","M0579","Z0000","R229","H6123","K644","D2121","Z13220","Z1329","Z1159","Z131","G4700","Z733","Z79899","Z0101","H5203","R609","Z780","M7741","M79671","H40013","K529","M0580","F330","Z23","M79672","M7752","R6889","M7989","Z1231","F419","F32A","K625","S31831A","M069","M659","F4320","L821","M2011","M21611","M19071","R2241","M25571","R1909","N3941","M05871","K6289","Z1211","D124","Q432","M8580","M8589"],"date":["2023-02-13","2023-06-15","2025-06-02","2025-07-30","2025-04-09","2024-07-12","2024-09-19","2023-02-13","2025-07-30","2025-07-30","2025-07-30","2025-07-30","2024-11-16","2024-11-16","2025-06-02","2025-06-04","2024-06-03","2025-07-16","2024-06-04","2022-12-12","2024-08-12","2025-07-07","2024-03-04","2023-07-28","2025-05-22","2024-07-25","2024-08-12","2023-06-15","2022-01-01","2023-03-02","2024-03-19","2025-04-19","2025-04-19","2024-06-06","2024-06-09","2023-02-02","2023-02-02","2025-05-05","2022-11-29","2023-03-02","2023-03-02","2023-03-02","2023-02-07","2024-08-23","2025-04-09","2025-01-27","2022-11-28","2024-09-10","2022-11-16","2022-11-16","2022-11-16","2022-10-12","2022-10-12"],"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":[["","","METHOTREXATE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","LEUCOVORIN CALCIUM","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":""}]}]}