{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Bethine A Sordyl Crook","gend":1,"currentgend":"","add":"15 UPPER DUNBAR RD","city":"SEAL HARBOR","state":"ME","zip":"04675","dob":"1935-03-19","age":"","mstatus":"","insh":"10000093776","cliId":"","pno":2549792002,"cno":8102497729,"email":"bethinesc@yahoo.com","ename":"","eno":"","pphy":"ONO, RODNEY T","ppno":2072885024,"pcpadd":"Cooper Gilmore Health Center,17 Hancock St","pcpcity":"Bar Harbor","pcpstate":"ME","pcpzip":"04609","pcpcounty":"","pcpid":"","pcpname":"COOPER GILMORE HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 24","madd2":"","madd3":"","mcity":"SEAL HARBOR","mstate":"ME","mzip":"04675","pcpfaxno":2072882902,"pcpnpi":1477626802,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8X23G81WW08","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R413","F411","R441","H9193","R0602","I951","R5383","I129","H6123","H9313","G3184","S22060A","R350","M5450","S81811A","Z0000","M5489","H26493","H43813","H4321","M4850XA","I10","R41844","F349","N1831","M48061","M5126","M47817","M4854XA","M4805","M5114","M4856XA","M4316","M5127","R0600","H903","I259","H26491","I6523","Z23","R431","Z5189"],"date":["2024-04-01","2025-05-01","2025-06-16","2024-07-19","2025-03-17","2022-10-31","2025-03-17","2025-04-02","2024-07-19","2024-07-19","2024-07-19","2022-12-21","2022-12-19","2022-12-19","2025-06-02","2025-06-09","2022-12-19","2024-07-15","2024-07-15","2024-07-15","2022-12-19","2023-11-15","2023-12-18","2023-11-15","2022-10-13","2022-12-20","2022-12-20","2022-12-20","2022-12-21","2022-12-20","2022-12-20","2022-12-20","2022-12-20","2022-12-20","2023-06-08","2024-11-26","2023-06-20","2022-11-07","2023-11-28","2022-10-14","2023-12-05","2025-01-28"],"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":""}]}]}