{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dawn A Dufkin Britt","gend":1,"currentgend":"","add":"888 BREWER LAKE RD","city":"ORRINGTON","state":"ME","zip":"04474","dob":"1954-09-30","age":"","mstatus":"","insh":"10000082501","cliId":"","pno":2078253333,"cno":"","email":"ddufkinbritt@gmail.com","ename":"","eno":"","pphy":"MALAY, DEVON C","ppno":2079073777,"pcpadd":"St Joseph Internal Medicine,900 Broadway Bldg 5","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"888 BREWER LAKE RD","madd2":"","madd3":"","mcity":"ORRINGTON","mstate":"ME","mzip":"04474","pcpfaxno":2077778800,"pcpnpi":1881210193,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7N90U60ET02","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1231","R6889","M25551","M7631","M85861","E66811","Z1211","Z0000","R053","C50911","Z471","Z96643","M5450","M48061","M5127","M47817","M4316","Z96641","Z0101","H5213","Z780","D649","G500","F4321","G43909","M6528","R200","Z23","M5136","H43811","M25552","Z7722","K5730","M47816","M419","Z13220","T8484XA","M7582","M19012","M25512","Z7982"],"date":["2025-03-13","2023-05-03","2024-07-05","2024-05-16","2024-05-16","2025-02-11","2025-05-27","2025-06-02","2023-12-11","2025-02-11","2025-07-15","2025-07-15","2025-05-16","2023-02-28","2023-02-28","2023-02-28","2023-02-28","2024-05-13","2025-10-29","2025-10-29","2025-05-30","2023-06-08","2022-12-06","2022-12-06","2022-12-06","2023-01-06","2023-01-26","2023-01-26","2023-01-26","2025-10-29","2023-01-06","2023-06-06","2023-06-06","2025-05-16","2025-05-16","2023-06-08","2024-03-29","2022-10-17","2022-10-17","2022-08-25","2022-08-25"],"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":[["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","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":""}]}]}