{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marion C Meacci","gend":1,"currentgend":"","add":"1428 BRANCH RD","city":"WELLS","state":"ME","zip":"04090","dob":"1949-02-22","age":"","mstatus":"","insh":"10000093719","cliId":"","pno":2072513983,"cno":"","email":"","ename":"","eno":"","pphy":"CONNOLLY, MARY J","ppno":2078741489,"pcpadd":"100 FODEN RD WEST,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1428 BRANCH RD","madd2":"","madd3":"","mcity":"WELLS","mstate":"ME","mzip":"04090","pcpfaxno":2078741483,"pcpnpi":1558535559,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5K65HM9RT89","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F329","G4733","E6601","Z6843","R490","S0990XA","R0789","M109","F411","F331","Z23","Z1231","M25562","F3342","M47816","N1832","Z1211","M25561","F419","S199XXA","E039","M940","M79672","Z0001","I2720","Z87891","R262","M8588","Q6651","M2141","M2142","M19072","Z1159","E7800","R202","Z9989","Z0000","M51361","M7732","M25462","M25551","S0003XA","Q6652","M79671","G894","F330","Z7902","Z96652","H43812","H04123","M180","M47817","M4317","M5450","M79644","M25552","M79645","M1811","M1812","Z7901","Z0101","H5203","D3131","H25813","Z8673","Z6844","G459","I6523","I6782","J029","U071","I6621","R200"],"date":["2025-11-18","2025-11-18","2025-02-28","2025-02-28","2023-06-23","2025-06-20","2025-04-18","2024-08-28","2025-07-11","2025-07-11","2024-10-11","2025-01-03","2025-05-09","2025-01-03","2025-09-25","2025-10-03","2023-03-03","2023-03-03","2025-04-08","2025-06-20","2025-10-03","2025-04-18","2024-06-28","2024-04-26","2023-12-18","2025-06-20","2024-11-08","2025-01-03","2024-06-28","2023-06-16","2023-06-16","2023-06-16","2025-05-02","2025-05-02","2023-01-16","2023-01-16","2025-05-02","2025-05-06","2023-03-03","2023-03-03","2023-03-03","2025-06-20","2024-06-28","2024-06-28","2025-02-28","2025-02-28","2025-06-20","2024-10-25","2022-10-19","2022-10-19","2022-09-14","2022-08-12","2022-08-12","2022-08-12","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-07-14","2022-05-13","2022-05-13","2022-05-13","2022-05-13","2022-04-15","2022-04-15","2022-03-31","2022-03-16","2022-03-16","2022-01-08","2022-01-08","2022-02-18","2022-02-18"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CELECOXIB","","","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":""}]}]}