{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Deborah J Reynolds","gend":1,"currentgend":"","add":"60 SUMMER STREET UNIT B","city":"Yarmouth","state":"ME","zip":"04096","dob":"1951-07-01","age":"","mstatus":"","insh":"10000090688","cliId":"","pno":2077769933,"cno":"","email":"wreynol1@maine.rr.com","ename":"","eno":"","pphy":"FRASER, ROBERT J","ppno":2077745816,"pcpadd":"100 FODEN RD. W,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41066143","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"60 SUMMER STREET UNIT B","madd2":"","madd3":"","mcity":"Yarmouth","mstate":"ME","mzip":"04096","pcpfaxno":2078741483,"pcpnpi":1134206352,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4K93W13TC99","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z421","C50912","M25551","Z23","D0512","M25552","D492","R1909","M1612","M67854","M1712","R4182","F3181","Z0001","M25559","R1900","R079","M160","M67853","M1611","M1610","R6889","R928","E785","E7800","K219","Z01818","K439","Z0100","C50812","R110","Z170","Z853","L821","H6123","N6489","K429","Z471","Z96641","M8580","F419","R922","N6002","N650","Z9013","F1320","C50911","F319","Z428","H903","J029","J069","Z03818","Z9882","R69","M8588","Z1231","M7061","Z1211","M169","H9190","M3390","Z87828","Z20822"],"date":["2024-04-25","2023-05-18","2025-05-07","2025-10-27","2023-02-16","2025-07-07","2024-10-28","2025-10-20","2025-07-07","2024-11-13","2025-07-07","2025-06-27","2025-10-01","2025-06-27","2024-10-10","2025-10-20","2023-10-08","2024-10-10","2024-11-13","2025-01-23","2025-01-16","2023-10-11","2022-12-22","2025-06-27","2023-02-16","2023-02-16","2024-12-30","2025-10-30","2023-10-10","2022-12-29","2023-10-08","2022-12-29","2024-08-28","2024-10-28","2025-06-11","2022-12-14","2025-10-22","2025-04-08","2025-02-10","2025-06-27","2025-10-01","2022-12-14","2022-12-14","2024-04-25","2024-04-25","2024-05-02","2023-05-18","2023-09-05","2024-04-25","2025-04-02","2025-09-05","2025-09-05","2025-09-05","2024-01-04","2025-02-01","2022-11-23","2022-11-23","2022-09-14","2022-07-11","2022-07-11","2022-07-11","2022-07-11","2022-04-28","2022-01-06"],"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":[["","","FLUAD TRIVALENT 2024-2025","","","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":""}]}]}