{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susannah M Babcock","gend":1,"currentgend":"","add":"4 E BROADWAY","city":"Lincoln","state":"ME","zip":"04457","dob":"1954-03-29","age":"","mstatus":"","insh":"10000095571","cliId":"","pno":2074477139,"cno":"","email":"goodnewsonly21@gmail.com","ename":"","eno":"","pphy":"PERFECT, JODIE","ppno":2077946700,"pcpadd":"175 W BROADWAY,PO BOX 99","pcpcity":"LINCOLN","pcpstate":"ME","pcpzip":"44574000","pcpcounty":"","pcpid":"","pcpname":"HEALTH ACCESS NETWORK","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"4 E BROADWAY","madd2":"","madd3":"","mcity":"Lincoln","mstate":"ME","mzip":"04457","pcpfaxno":2077946777,"pcpnpi":1417399205,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1M41E34CT27","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01812","R7303","M1712","R3915","Z471","M25562","E669","L570","I10","Z0000","E559","M170","M1711","M25552","Z01818","M25561","F900","E6601","E782","R739","Z780","R399","Z713","Z1231","S91331A","L814","L821","Z7189","M48061","M5126","M47817","M4316","R6889","N390","F329","Z96652","M222X1","Z0101","M1612","R300","Z6841","D1801","N3001","S83102A","X58XXXA"],"date":["2024-12-17","2025-06-02","2025-02-05","2023-11-15","2025-02-21","2024-12-17","2024-12-17","2025-04-23","2025-03-26","2025-09-18","2024-04-02","2024-12-17","2025-04-25","2025-09-04","2025-01-08","2022-10-17","2023-05-17","2023-03-03","2024-04-02","2023-03-03","2023-09-28","2024-07-11","2023-09-06","2025-04-29","2023-10-02","2025-04-23","2025-04-23","2025-04-23","2025-09-04","2025-09-04","2025-09-04","2025-09-04","2023-03-14","2024-07-11","2022-12-14","2025-03-04","2023-02-15","2024-03-15","2025-08-05","2024-09-11","2023-05-12","2025-04-23","2023-11-15","2023-03-21","2023-03-21"],"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":[["","","ATENOLOL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","ZILRETTA","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","GUANFACINE HCL","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","GEMFIBROZIL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","DEXAMETHASONE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}