{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Diane M Estey","gend":1,"currentgend":"","add":"739 EDINBURG RD","city":"HOWLAND","state":"ME","zip":"04448","dob":"1955-11-21","age":"","mstatus":"","insh":"10000080757","cliId":"","pno":2072496645,"cno":"","email":"dgasch@icloud.com","ename":"","eno":"","pphy":"ADAMS, KATIE M","ppno":2079737979,"pcpadd":"PO BOX 99,","pcpcity":"LINCOLN","pcpstate":"ME","pcpzip":"44570099","pcpcounty":"","pcpid":"","pcpname":"HEALTH ACCESS NETWORK","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"P O BOX 13","madd2":"","madd3":"","mcity":"HOWLAND","mstate":"ME","mzip":"04448","pcpfaxno":2077948476,"pcpnpi":1154764975,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2Q64V22YV91","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79645","M1812","D0512","K2980","K449","K5710","Z1231","G4733","Z0101","M25551","H5213","I3481","M25562","F4322","Z0000","Z87898","Z87891","C50912","I10","E039","R7309","E782","G629","I3139","R921","R920","H40003","Z170","Z510","K6389","K219","N6489","J449","K529","R1011","K6289","Z0189","Z923","C50911","Z803","R140","R928","N610","L918","E6601","C50412","Z780","R040","Z09","M1712","M160","N6313","M48061","M5116","M4727","M4317","R6889","Z483","Z86000","Z7183","E739","M159","R109","N6092","N6082","M1611","M1711","M5450","Z713","J441"],"date":["2025-10-13","2025-10-13","2025-10-22","2023-01-26","2023-01-26","2023-01-26","2024-04-08","2025-10-25","2025-07-07","2025-07-03","2025-07-07","2024-04-25","2024-04-29","2024-06-03","2025-06-02","2025-10-16","2025-10-16","2025-04-21","2025-05-27","2025-05-27","2024-02-13","2025-05-27","2024-02-13","2024-04-25","2024-08-16","2024-08-16","2024-07-01","2024-09-20","2024-12-02","2022-12-06","2024-04-03","2025-04-14","2025-04-03","2025-04-09","2023-03-08","2023-03-08","2022-12-20","2025-04-23","2024-09-19","2024-09-19","2025-04-09","2025-10-02","2025-04-11","2024-03-13","2025-04-09","2024-09-20","2023-04-07","2025-10-07","2025-04-29","2025-02-24","2024-04-29","2024-05-13","2025-07-03","2025-07-03","2025-07-03","2025-07-03","2023-05-01","2024-10-07","2025-04-23","2024-09-19","2023-01-26","2024-12-30","2022-12-06","2024-06-12","2024-06-12","2025-06-27","2025-06-27","2025-06-27","2022-11-16","2022-09-06"],"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":[["","","ANORO ELLIPTA","","","Select","Select",""],["","","MESALAMINE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","LOVASTATIN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","LETROZOLE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","MOMETASONE FUROATE","","","Select","Select",""],["","","ANASTROZOLE","","","Select","Select",""],["","","XIFAXAN","","","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":""}]}]}