{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rhonda Green","gend":1,"currentgend":"","add":"156 SHERIDAN ST UNIT 1A","city":"PORTLAND","state":"ME","zip":"04101","dob":"1956-07-18","age":"","mstatus":"","insh":"10000087146","cliId":"","pno":6174498511,"cno":"","email":"","ename":"","eno":"","pphy":"KNIGHT, CARLEEN R","ppno":2077986200,"pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"156 SHERIDAN ST UNIT 1A","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04101","pcpfaxno":2077986290,"pcpnpi":1043589443,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3U68WF9XM64","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C20","Z1231","K56699","I4821","I340","Z432","K9171","R4182","Z85048","Z48815","Z1211","K9189","R011","I081","L728","B353","L988","L818","C187","C19","L570","K9130","I4891","K9419","D696","Z0100","R198","Z01810","Z13228","R918","K633","L271","D539","I501","K435","K5730","N83201","I4720","I4820","Z08","Z923","A000","Z538","K624","Z980","E213","Z13220","Z136","G8918","Z932","D128","Z23","E8352","Z510"],"date":["2025-06-09","2025-06-09","2024-05-22","2025-05-06","2025-05-06","2023-06-28","2023-06-28","2024-06-27","2024-06-27","2023-07-05","2024-06-27","2024-06-27","2024-06-27","2025-07-28","2024-07-24","2024-07-24","2024-07-24","2024-07-24","2023-03-20","2023-01-26","2025-07-28","2024-06-11","2023-09-19","2023-05-01","2025-06-09","2023-09-12","2023-08-17","2023-03-07","2025-04-10","2024-12-03","2023-08-17","2024-02-26","2024-02-26","2025-07-28","2023-06-28","2024-06-27","2023-03-21","2024-04-29","2023-07-31","2023-04-25","2023-04-25","2023-03-27","2024-04-18","2024-04-18","2024-04-18","2025-04-10","2025-04-10","2023-10-16","2023-03-20","2023-09-19","2022-11-18","2022-10-25","2022-10-20","2022-09-12"],"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":[["","","ELIQUIS","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","NEOMYCIN SULFATE","","","Select","Select",""],["","","OXYCODONE HCL","","","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":""}]}]}