{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sheila J Randall","gend":1,"currentgend":"","add":"49 Rutland St","city":"Bangor","state":"ME","zip":"04401","dob":"1949-12-07","age":"","mstatus":"","insh":"10000091080","cliId":"","pno":2079473576,"cno":"","email":"sheand@msn.com","ename":"","eno":"","pphy":"Sharon K Roxas","ppno":2079073777,"pcpadd":"Emmc Family Medicine Of Brewer,234 State St","pcpcity":"Brewer","pcpstate":"ME","pcpzip":"04412","pcpcounty":"","pcpid":"","pcpname":"St Joseph Family Medicine","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"49 Rutland St","madd2":"","madd3":"","mcity":"Bangor","mstate":"ME","mzip":"04401","pcpfaxno":2079073778,"pcpnpi":1912211483,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8P58U53EM43","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5442","I10","G9389","Z85841","I493","R7303","D496","Z0000","Z1231","E669","G3184","K580","K760","E804","E6601","Z6841","Z09","Z96651","Z96652","Z471","Z96653","E042","R1310","I209","Z780","Z0101","G930","L309","G8929","J302","R200","R29898","M1612","M25552","B379","M5116","M4726","M4316","E079","Z1211","M5416","M25551","L720","R6889","H903","F458","L270","G119","M5450","M25562","G253","Z87891","I5189","R002","Z96659","Z01818","H40013","D440","M25661","M25662","K529","R251","H5310","Z8669","R2681"],"date":["2024-06-27","2025-01-13","2024-09-20","2024-09-20","2024-07-01","2024-07-01","2024-07-01","2025-01-02","2024-09-11","2025-06-23","2025-07-28","2023-06-22","2023-06-22","2023-03-27","2024-12-09","2024-12-09","2024-04-23","2024-04-23","2024-04-23","2022-10-03","2023-10-04","2024-11-20","2024-11-20","2024-02-20","2023-07-10","2025-05-07","2024-09-20","2024-09-12","2023-10-10","2023-11-10","2023-10-10","2023-10-10","2024-02-14","2024-03-26","2024-08-08","2024-04-06","2024-04-06","2024-04-06","2023-08-10","2024-07-10","2023-11-21","2024-02-09","2024-08-08","2023-08-09","2024-08-20","2023-03-23","2023-03-23","2023-03-28","2023-10-11","2023-12-28","2023-03-28","2023-03-28","2022-09-20","2024-02-20","2023-10-05","2022-08-24","2024-04-22","2023-11-15","2023-10-04","2023-10-04","2023-03-27","2023-03-23","2025-05-07","2022-09-14","2022-09-14"],"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":[["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":""}]}]}