{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Martha T Burke","gend":1,"currentgend":"","add":"8 MAPLE DR","city":"NORTHFIELD","state":"ME","zip":"04654","dob":"1956-05-09","age":"","mstatus":"","insh":"10000086805","cliId":"","pno":2072550932,"cno":"","email":"lesther414@aol.com","ename":"","eno":"","pphy":"QUINN, JENNIFER L","ppno":2072552772,"pcpadd":"110 STONE ST,","pcpcity":"ONEIDA","pcpstate":"NY","pcpzip":"13421213","pcpcounty":"","pcpid":"","pcpname":"DOWN EAST HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 582","madd2":"","madd3":"","mcity":"MACHIAS","mstate":"ME","mzip":"04654","pcpfaxno":"","pcpnpi":1952670069,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6MH4MW3HJ62","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z124","I83813","D225","L821","L814","D2272","D485","Z1151","Z01419","I10","L820","R208","L7211","L918","D2371","Z0000","Z1211","Z803","K635","K5730","Z0101","H5213","L718","R6889","Z13220","R635","Z1329","Z1231","B351","L570","R739","E785","E039","M8589","S61212A","W230XXA","Y92015"],"date":["2023-04-28","2025-01-27","2025-07-16","2025-07-16","2025-07-16","2025-07-16","2025-01-09","2023-04-28","2023-04-28","2025-06-27","2023-06-08","2023-06-08","2023-03-03","2023-03-03","2023-03-03","2025-06-27","2023-05-22","2023-04-28","2023-05-22","2023-05-22","2024-10-03","2024-10-03","2023-12-12","2023-09-25","2023-03-14","2024-12-19","2023-09-20","2025-07-17","2024-12-17","2024-12-17","2025-06-27","2025-06-27","2025-06-27","2023-09-19","2022-07-04","2022-07-04","2022-07-04"],"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":[["","","METRONIDAZOLE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","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":""}]}]}