{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jane Y Lopes","gend":1,"currentgend":"","add":"1 PRIVATE DR","city":"Winslow","state":"ME","zip":"04901","dob":"1943-11-27","age":"","mstatus":"","insh":"10000080180","cliId":"","pno":2076600053,"cno":"","email":"","ename":"","eno":"","pphy":"PHELPS, JULIE J","ppno":"","pcpadd":"Waterville Family Practice,31 Front St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"WATERVILLE FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1 PRIVATE DR","madd2":"","madd3":"","mcity":"Winslow","mstate":"ME","mzip":"04901","pcpfaxno":2078731186,"pcpnpi":1679562979,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6J93U25XC00","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J449","I5022","R0602","R0902","Z789","R918","I7121","I5021","U071","E210","Z87891","L820","Z1331","E213","R0600","H353121","Z961","I10","Z743","Z7951","H353131","Z0000","I340","I509","K5732","I2510","I77810","I252","Z955","R198","R1031","R1013","H524","H26499","H52229","E8352","E559","H52223","I499","J9620","R911","I5030","I222","R0609","Z09","K8020","K8689","I480","E7849"],"date":["2025-11-12","2025-11-12","2024-02-09","2024-02-08","2024-02-08","2024-04-01","2024-04-01","2024-05-12","2024-05-12","2024-12-05","2025-09-23","2023-04-10","2024-03-01","2024-10-08","2024-02-08","2024-04-29","2024-04-29","2024-02-08","2024-02-08","2025-09-23","2025-04-25","2024-05-15","2023-10-10","2024-02-09","2024-10-30","2024-02-20","2023-08-24","2024-02-09","2023-08-24","2024-09-26","2024-09-26","2024-09-26","2023-08-24","2023-08-24","2023-08-24","2024-02-22","2024-02-22","2024-10-18","2024-02-09","2024-02-09","2023-05-22","2024-10-23","2023-10-11","2023-10-10","2024-02-13","2023-05-19","2023-05-19","2022-08-09","2022-08-09"],"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":[["","","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":[]}},{"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":""}]}]}