{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Alan F Lane","gend":0,"currentgend":"","add":"15 MEMORY LN","city":"LINCOLN","state":"ME","zip":"04457","dob":"1946-10-22","age":"","mstatus":"","insh":"10000089370","cliId":"","pno":2074039266,"cno":"","email":"","ename":"","eno":"","pphy":"ALESSI, CARL F","ppno":2077943296,"pcpadd":"Penobscot Valley Hospital,7 Transalpine Rd","pcpcity":"Belfast","pcpstate":"ME","pcpzip":"04915","pcpcounty":"","pcpid":"","pcpname":"PENOBSCOT VALLEY PRIMARY CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"15 MEMORY LN","madd2":"","madd3":"","mcity":"LINCOLN","mstate":"ME","mzip":"04457","pcpfaxno":2077948072,"pcpnpi":1144214271,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8E54YV1EJ61","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H353231","H2513","Z885","Z87891","N400","G4700","H3530","N9989","Z125","M9903","M5450","M9904","M9906","Z0000","Z23","Z136","Z1211","R319","N281","Z87448","B351","L989","Z0100","H35711","N421","Z83518","Z1152","Z7982","Z48816","I868","N201","S80812A","R310","Z09","H6121","R059","M79671","Z1212","Z0101","L821","Z01812"],"date":["2025-07-24","2025-07-24","2023-09-18","2025-07-24","2024-10-28","2024-10-28","2024-10-28","2024-05-02","2023-04-25","2025-09-25","2025-09-25","2025-09-25","2025-09-25","2025-07-10","2025-07-09","2025-07-09","2025-07-18","2024-05-02","2023-04-17","2023-04-26","2023-08-21","2024-04-30","2025-09-09","2023-01-25","2024-04-16","2025-07-24","2025-01-22","2024-08-19","2024-06-03","2024-05-02","2024-05-02","2024-10-28","2024-04-26","2025-07-28","2023-08-21","2025-01-22","2025-01-29","2025-07-18","2022-08-09","2022-08-01","2022-06-27"],"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":[]}},{"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":""}]}]}