{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jane E Bell","gend":1,"currentgend":"","add":"25 TIDE MILL RD","city":"Edmunds Twp","state":"ME","zip":"04628","dob":"1952-10-31","age":"","mstatus":"","insh":"10000081789","cliId":"","pno":2072635053,"cno":"","email":"eaglenest1765@gmail.com","ename":"","eno":"","pphy":"MOULTON, CHRISTINE C","ppno":2072550102,"pcpadd":"Regional Medical Center at Lubec,893 Main St","pcpcity":"East Machias","pcpstate":"ME","pcpzip":"04630","pcpcounty":"","pcpid":"","pcpname":"REGIONAL MEDICAL CENTER AT LUBEC","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"25 TIDE MILL RD","madd2":"","madd3":"","mcity":"Edmunds Twp","mstate":"ME","mzip":"04628","pcpfaxno":2077332127,"pcpnpi":1588643886,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1DY4TA5VA90","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M9901","S134XXA","M9902","M9904","D508","Z1231","R059","H21233","H2513","I80292","M79671","R350","M722","M79605","I8392","R310","N952","N390","R300","D509","E611","Z136","M79672","I776","R6889","L03116","I10"],"date":["2025-02-10","2025-02-10","2025-02-10","2025-02-10","2025-02-12","2025-04-10","2024-04-10","2023-04-06","2023-04-06","2024-11-21","2023-06-15","2025-05-22","2025-05-05","2025-09-04","2025-09-04","2025-04-24","2024-02-01","2024-12-30","2025-05-22","2025-09-09","2025-02-12","2025-02-12","2024-01-04","2025-09-09","2023-12-22","2025-09-02","2024-02-01"],"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":[["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","LOPERAMIDE","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ESTRADIOL","","","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":""}]}]}