{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ardene G Ward","gend":0,"currentgend":"","add":"516 MT HOPE AVE","city":"BANGOR","state":"ME","zip":"04401","dob":"1944-01-13","age":"","mstatus":"","insh":"10000083711","cliId":"","pno":2077355953,"cno":"","email":"karenherseyward@gmail.com","ename":"","eno":"","pphy":"TAGUE, COURTNEY","ppno":2078664399,"pcpadd":"EMMC Orono Family Medicine,84 Kelley Rd","pcpcity":"Orono","pcpstate":"ME","pcpzip":"04473","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"33 COUNTY RD","madd2":"","madd3":"","mcity":"CORINTH","mstate":"ME","mzip":"04427","pcpfaxno":2078664538,"pcpnpi":1679953194,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1P22HM6JU26","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11319","R296","G309","D869","J189","L570","E1122","N1830","E1121","G301","E0822","R7401","K7460","Z739","R278","D860","E871","L821","D1801","Z7189","Z08","R338","R109","W0110XA","Y92009","S299XXA","S0990XA","S199XXA","I2510","I10","Z23","F02B18","G4700","J181","N481","F02B0","F3341","E538","R918","R001","R339","K5900","R350","K7689","F0280"],"date":["2023-04-17","2025-06-30","2024-10-15","2024-10-15","2024-10-15","2023-07-25","2023-04-17","2023-04-17","2023-04-17","2025-02-04","2025-06-30","2023-10-18","2023-10-18","2024-01-01","2025-06-30","2025-01-05","2023-10-11","2023-07-25","2023-07-25","2023-07-25","2023-07-25","2025-05-24","2023-10-03","2023-10-03","2023-10-03","2023-10-03","2023-10-03","2023-10-03","2023-11-29","2023-12-11","2025-02-10","2023-07-27","2023-04-19","2024-06-29","2023-11-29","2023-04-19","2023-04-19","2022-10-11","2025-05-13","2023-12-11","2025-05-24","2024-10-15","2023-01-09","2023-10-04","2022-07-21"],"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":[["","","PREVNAR 20","","","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":""}]}]}