{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"James A Derbyshire","gend":0,"currentgend":"","add":"46 SUMMER ST","city":"Skowhegan","state":"ME","zip":"04976","dob":"1950-08-20","age":"","mstatus":"","insh":"10000086988","cliId":"","pno":2074743549,"cno":"","email":"declined@10162025.com","ename":"","eno":"","pphy":"ZAVOTSKY, DIANE","ppno":2076724187,"pcpadd":"Bingham Area Health Center,237 Main St","pcpcity":"Bingham","pcpstate":"ME","pcpzip":"04950","pcpcounty":"","pcpid":"","pcpname":"MADISON AREA HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"46 SUMMER ST","madd2":"","madd3":"","mcity":"Skowhegan","mstate":"ME","mzip":"04976","pcpfaxno":2076723641,"pcpnpi":1023128261,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8E97XX0DP39","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G20A1","I080","Z006","Z952","I700","Z48812","Z736","I081","I350","I5033","J9601","Z515","G20C","N390","F1020","E7800","Z953","J90","R195","R531","I340","I4891","R570","Z95818","M9903","M5450","M9904","M5417","F1021","I5032","G629","H6123","I352","Z98890","D649","R4182","I672","M48061","M5126","S22000D","Z452","J811","R0989","N189","M549","Z01810","S22070A","I6381","I480","R011","R059","Z743","S0993XA","I50810","I422","I440","I6523","Z4682","M5135","S22000A","G9349","S229XXA","I341","R7881","R569","Z23","Z0101","A4181","E639","A419","I330","B961","I2510","R399","R251","I339","N281","R69","G250","H2512","H5703","G20","H2513","H2511"],"date":["2024-11-03","2025-06-12","2025-01-29","2025-01-28","2024-10-17","2024-12-04","2024-11-03","2025-03-20","2025-08-28","2024-10-17","2024-10-17","2024-10-16","2024-10-16","2025-05-06","2023-09-06","2023-06-07","2024-10-18","2025-01-26","2024-10-24","2025-03-23","2025-07-11","2025-05-29","2024-10-16","2025-01-28","2025-10-13","2025-10-13","2025-10-13","2025-10-13","2024-08-15","2025-01-26","2025-08-14","2025-02-13","2025-09-11","2025-03-20","2025-01-28","2025-01-28","2025-09-25","2025-09-25","2025-09-25","2024-04-25","2024-10-15","2024-10-15","2024-10-11","2024-10-11","2023-08-02","2024-10-16","2024-04-25","2025-10-30","2024-10-17","2024-10-17","2024-10-20","2024-10-11","2024-10-13","2024-10-12","2024-10-12","2025-03-20","2024-10-12","2024-10-13","2025-09-25","2024-05-09","2025-03-23","2024-03-14","2025-07-11","2025-07-31","2024-03-18","2023-09-06","2023-11-10","2025-03-23","2023-12-29","2025-04-28","2025-05-04","2025-05-04","2025-07-11","2025-04-01","2024-03-06","2025-04-17","2025-03-26","2025-04-03","2022-10-26","2022-09-26","2022-09-26","2022-08-16","2022-08-22","2022-08-22"],"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":[]},{"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}