{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Walter N House","gend":0,"currentgend":"","add":"560 RUMFORD RD","city":"OQUOSSOC","state":"ME","zip":"04964","dob":"1936-10-22","age":"","mstatus":"","insh":"10000100101","cliId":"","pno":2078645083,"cno":"","email":"","ename":"","eno":"","pphy":"ZAVOTSKY, DIANE","ppno":2076724187,"pcpadd":"Bingham Area Health Center,237 Main St","pcpcity":"Bingham","pcpstate":"ME","pcpzip":"00000","pcpcounty":"","pcpid":"","pcpname":"RANGELEY FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"P.O. BOX 201","madd2":"","madd3":"","mcity":"OQUOSSOC","mstate":"ME","mzip":"04964","pcpfaxno":2076723641,"pcpnpi":1023128261,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9EN4MX6HV94","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25562","E8779","I25119","I10","E785","M7989","G9341","R109","R933","I080","I5030","R0902","K8020","A071","E0590","E876","K567","R1319","R140","N289","H2511","I444","J90","N179","E43","R410","A4101","D62","R197","M25511","H2512","R7881","M25552","B9561","A419","I491","I252","S90822A","L989","Z789","K922","Z0000","E119","R6889","K921","D649","K529","R8271","I480","R6520","B9620","T796XXA","Z87891","E11621","L89312","H2513","K760","K5989","R112","I5033","Z23","Z79899","S2241XA","I2510","J810","R000","R0682","S91301A","M19071","M1712","R079","I700","Z043","R9089","I440","I459","R9431","K56609","R531","R1032","D72829","Z66","Z452","R918","K560","R160","Z96642","M79652","M85852","R0602","A09","N390","R2689","J189","Z792","B999","Z91138","R52","K6389","Z125","N189","K439","I498","R1310","R778","J9601","R609","S2249XB","S32009A","Z743","J811","I509","Z0101"],"date":["2025-04-18","2025-07-07","2025-07-07","2025-07-07","2025-07-07","2023-09-13","2025-07-18","2025-07-10","2025-07-07","2025-06-18","2025-06-18","2025-07-11","2025-07-07","2023-08-14","2023-08-09","2023-08-07","2025-06-27","2023-08-09","2025-06-23","2023-08-03","2022-12-20","2023-08-31","2025-07-16","2025-06-17","2023-08-11","2025-07-22","2025-06-25","2025-07-22","2025-06-17","2025-06-16","2023-01-10","2025-07-09","2025-07-09","2025-07-09","2025-07-18","2023-08-31","2023-08-30","2025-07-20","2025-07-20","2025-07-23","2025-07-22","2024-08-29","2024-09-18","2025-07-17","2025-06-29","2025-07-22","2023-09-01","2023-09-01","2023-09-01","2023-09-04","2023-09-04","2025-06-16","2023-07-20","2024-10-09","2023-12-13","2022-12-07","2025-06-23","2025-06-23","2025-06-25","2025-07-21","2024-09-12","2025-07-19","2025-06-19","2025-06-24","2025-07-11","2025-07-10","2025-07-10","2025-06-17","2025-06-17","2025-06-17","2025-06-16","2025-07-16","2025-06-16","2025-06-16","2023-07-28","2023-07-28","2023-07-28","2025-06-27","2025-07-22","2023-08-30","2023-08-30","2023-08-30","2025-06-21","2025-06-21","2025-06-23","2025-06-23","2025-06-24","2025-06-24","2025-06-24","2025-07-10","2023-08-30","2023-08-30","2025-07-09","2025-07-09","2025-07-19","2025-07-19","2025-07-19","2025-07-19","2023-08-04","2024-09-12","2024-09-12","2023-07-30","2023-08-31","2023-08-10","2023-08-30","2025-07-11","2023-08-17","2025-06-25","2025-06-25","2025-06-25","2025-07-16","2025-07-16","2022-11-18"],"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":[["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","HALOPERIDOL LACTATE","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","LORAZEPAM","","","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":""}]}]}