{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Theodore J Pettengill","gend":0,"currentgend":"","add":"22 WILLOW ST","city":"PATTEN","state":"ME","zip":"04765","dob":"1947-04-06","age":"","mstatus":"","insh":"10000091983","cliId":"","pno":2075282633,"cno":2074414765,"email":"2tpett22@fairpoint.net","ename":"","eno":"","pphy":"Olabiyi, Solomon B","ppno":2075322234,"pcpadd":"SIGRID E TOMPKINS HEALTH CENTER,22 HARTFORD ST","pcpcity":"HOULTON","pcpstate":"ME","pcpzip":"04730","pcpcounty":"","pcpid":"","pcpname":"SIGRID E TOMPKINS HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 384","madd2":"","madd3":"","mcity":"PATTEN","mstate":"ME","mzip":"04765","pcpfaxno":2075329426,"pcpnpi":1366734170,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6C53U93ER17","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E559","R0609","H26491","H26492","H43812","H43811","H26493","H43813","H02831","H02834","Z0000","I350","I4891","I517","I498","I2510","R69","S2242XA","R7401","B029","M549","R0600","R079","I10","S61211A","W312XXA","R9439","R0789","I119","R6889","S60454A","R002"],"date":["2023-12-13","2023-08-28","2023-12-14","2023-12-14","2023-12-14","2023-12-14","2024-12-19","2024-12-19","2024-12-19","2024-12-19","2024-12-11","2024-10-29","2024-10-29","2024-10-29","2024-10-01","2023-12-19","2025-06-11","2023-04-25","2024-12-11","2023-06-05","2023-06-13","2023-12-19","2023-12-19","2023-12-19","2024-11-06","2024-11-06","2023-07-27","2023-07-27","2023-07-27","2023-01-01","2024-01-04","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":""}]}]}