{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Irmgard Jacobs","gend":1,"currentgend":"","add":"56 ECHO LAKE RD","city":"Mount Desert","state":"ME","zip":"04660","dob":"1937-10-18","age":"","mstatus":"","insh":"10000092550","cliId":"","pno":2072447063,"cno":2078018097,"email":"declined@05122025.com","ename":"","eno":"","pphy":"NEAL, NATASHA S","ppno":2072445630,"pcpadd":"MDI Community Health Center,PO Box 1130","pcpcity":"Southwest Harbor","pcpstate":"ME","pcpzip":"04679","pcpcounty":"","pcpid":"","pcpname":"MDI COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 782","madd2":"","madd3":"","mcity":"MOUNT DESERT","mstate":"ME","mzip":"04660","pcpfaxno":"","pcpnpi":1760989974,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5K54Y34PD96","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4891","R21","R600","E860","H608X3","J310","J3489","R140","H40013","H02825","H3581","Z0000","I083","I2720","I351","R002","R197","M7989","K645","M9901","M5412","J302","H35363","H43393","H26493","N390","K6289","R399","S81812A","L508","L2089","L2989","R457","N952","L239","H35361","H35722","H35362","R000","R0981","M79671"],"date":["2024-12-16","2024-07-03","2025-07-25","2023-02-08","2023-02-08","2023-02-08","2023-02-08","2025-08-04","2022-12-27","2023-01-06","2024-12-03","2024-12-09","2023-10-10","2023-10-10","2023-09-11","2023-09-11","2025-08-04","2025-07-25","2023-11-17","2025-08-18","2025-08-18","2024-07-10","2022-12-27","2022-12-27","2022-12-27","2025-01-16","2023-11-15","2023-11-20","2025-07-21","2025-03-11","2025-04-10","2025-03-31","2025-02-26","2023-11-24","2025-03-31","2024-10-23","2024-10-23","2022-12-27","2023-01-11","2022-10-20","2022-09-29"],"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":""}]}]}