{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Joyce L Pereira","gend":1,"currentgend":"","add":"2279 INTERVALE RD","city":"BETHEL","state":"ME","zip":"04217","dob":"1957-08-21","age":"","mstatus":"","insh":"10000098425","cliId":"","pno":2078900704,"cno":"","email":"joyce@mahoosucreality.com","ename":"","eno":"","pphy":"HATHAWAY, JESSAMY","ppno":2078242193,"pcpadd":"Bethel Family Health Center,32 Railroad St","pcpcity":"Bethel","pcpstate":"ME","pcpzip":"04217","pcpcounty":"","pcpid":"","pcpname":"BETHEL FAMILY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 54","madd2":"","madd3":"","mcity":"BETHEL","mstate":"ME","mzip":"04217","pcpfaxno":2076610299,"pcpnpi":1467187187,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7G47KX1CG20","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I480","M170","M25552","Z1231","S82832A","S8292XA","I4892","E7800","Z0101","H524","S8391XA","I440","I4710","I454","Z0000","I483","I495","M1712","M4726","M4317","M1711","M85859","Z780","M76892","L738","L814","D2339","L813","H5203","R7303","Z7901","S82435A","G8918","I4891","E669","E559","I10","R4182","S8265XA","M7662","S8265XD","I358","I517","M160","Z96652","M25561","M48062","M8580","R718","Z01419","M25562","Z01818","L821","Z124"],"date":["2025-10-07","2025-04-18","2025-09-19","2025-10-20","2023-03-04","2023-03-04","2025-10-07","2025-11-03","2025-10-23","2024-08-13","2025-03-02","2025-08-07","2025-08-07","2025-08-07","2025-04-01","2025-01-24","2025-01-24","2025-11-10","2025-09-15","2025-09-15","2025-04-28","2025-04-17","2025-04-17","2025-08-29","2025-03-05","2025-03-05","2025-03-05","2025-03-05","2025-10-23","2025-09-25","2025-01-24","2023-03-04","2025-11-10","2025-11-10","2025-11-10","2025-02-11","2025-01-24","2025-01-24","2023-03-13","2023-04-11","2023-04-11","2023-12-26","2023-12-26","2025-08-29","2025-11-14","2025-11-14","2025-09-04","2025-04-17","2025-04-07","2024-10-16","2025-04-30","2025-10-27","2023-10-11","2022-10-13"],"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":[["","","GABAPENTIN","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","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":""}]}]}