{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert Benton","gend":0,"currentgend":"","add":"96 PLEASANT POND RD","city":"TURNER","state":"ME","zip":"04282","dob":"1957-09-27","age":"","mstatus":"","insh":"10000099197","cliId":"","pno":2077544671,"cno":2072242012,"email":"declined@122324.com","ename":"","eno":"","pphy":"WALL, JEFFREY A","ppno":2077847388,"pcpadd":"190 STETSON RD,","pcpcity":"AUBURN","pcpstate":"ME","pcpzip":"42107813","pcpcounty":"","pcpid":"","pcpname":"FAMILY HEALTH CARE ASSOCIATES","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"96 PLEASANT POND RD","madd2":"","madd3":"","mcity":"TURNER","mstate":"ME","mzip":"04282","pcpfaxno":2077952043,"pcpnpi":1447288808,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9RM0D86RX26","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","E119","I10","E785","E1165","H35033","D3132","E113213","F32A","E118","Z7984","E1129","Z1211","K635","Z86010"],"date":["2025-08-07","2024-07-25","2025-01-27","2024-07-25","2025-07-25","2025-03-21","2025-03-21","2025-03-21","2023-06-05","2024-01-25","2024-01-11","2025-01-27","2022-11-02","2022-11-02","2022-11-02"],"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":[["","","METFORMIN HCL","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ACCU-CHEK AVIVA PLUS","","","Select","Select",""],["","","ACCU-CHEK SOFTCLIX","","","Select","Select",""],["","","ACCU-CHEK FASTCLIX LANCET DRUM","","","Select","Select",""],["","","FLUZONE TRIVALENT 2024-2025","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","GAVILYTE-C","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":[]}]},{"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":""}]}]}