{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Melville Corey","gend":0,"currentgend":"","add":"148 BREAKWATER DR UNIT 18","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1937-08-19","age":"","mstatus":"","insh":"10000098124","cliId":"","pno":2076536342,"cno":"","email":"noemail@92223.com","ename":"","eno":"","pphy":"DAIGLE, JENNIFER K","ppno":"","pcpadd":"180 Park Ave,","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04102","pcpcounty":"","pcpid":"","pcpname":"PORTLAND COMMUNITY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"148 BREAKWATER DR UNIT 18","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":"","pcpnpi":1871547141,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3HE6PR6YN52","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T424X2A","Z1211","K5730","E785","R569","N281","K8020","Q231","Z954","R1110","R791","E871","D649","R9389","I2510","R221","E049","H2511","H5703","I6523","R2689","K639","K760","K5900","R42","W19XXXA","E441","R4182","Z0000","R102","G301","F02B3","D539","D61818","R1032","Z87891","I7121","K529","F332","R4189","I25118","Z0100","L280","R55","D229","G309","T50902A","F339","F0280","R6889","R140","L739","R21","S63512A","M19032","R0789","F32A","Z953","T18128A","R296","E7800","I671","T8131XD","T8131XA","L720","D692","L298","H2512","R918","I340","I371","Z952","J984","Z961","M5450","T68XXXA","I480","R6510","Z23","G928","Z66","R4020","T68XXXD","R1310","M542","K559","I6503","I428","I080","R2681","H538","N200","R109","R933","K5790","S299XXA","E860","R29810","R251","H259","S0990XA","S199XXA","W06XXXA","I4891","Z7901","L2989","M549","M8580","R079","R197","H2513"],"date":["2023-03-17","2023-12-29","2023-12-29","2023-12-29","2023-12-29","2024-07-02","2024-07-02","2023-05-04","2024-05-21","2023-01-06","2023-01-06","2024-01-03","2023-12-05","2024-07-05","2022-12-16","2023-06-29","2025-07-29","2023-08-23","2023-06-26","2023-11-30","2023-05-15","2023-10-25","2023-10-25","2024-01-09","2024-03-07","2024-02-17","2024-09-18","2023-11-30","2025-03-19","2024-07-02","2025-09-17","2025-09-17","2025-09-18","2025-09-17","2024-09-11","2024-09-11","2024-05-21","2023-12-29","2023-09-28","2023-06-12","2023-05-04","2025-09-09","2024-03-13","2024-02-29","2024-01-16","2023-03-23","2023-03-19","2023-03-18","2023-03-18","2023-08-23","2024-09-11","2025-10-26","2025-10-26","2023-01-31","2023-01-31","2024-06-24","2023-03-23","2023-03-09","2024-08-27","2024-07-02","2023-10-26","2023-11-30","2023-04-05","2023-03-30","2024-01-24","2024-01-24","2024-01-24","2023-03-29","2024-07-05","2023-01-17","2023-01-17","2023-01-17","2023-03-16","2023-08-23","2023-11-01","2023-03-17","2025-02-14","2023-03-17","2023-09-28","2023-03-17","2023-03-17","2023-03-16","2023-03-23","2024-11-12","2023-09-28","2023-05-12","2023-08-13","2024-05-21","2024-04-23","2023-11-16","2024-08-29","2024-09-11","2023-10-12","2023-12-29","2023-12-29","2024-02-17","2023-08-13","2023-08-13","2023-08-13","2023-06-26","2024-02-17","2024-02-17","2023-11-01","2023-11-01","2023-11-01","2025-10-26","2023-11-01","2023-11-01","2023-01-17","2023-12-29","2022-11-17"],"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":""}]}]}