{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dina M Richards","gend":1,"currentgend":"","add":"6 WESTERN AVE","city":"TOPSHAM","state":"ME","zip":"04086","dob":"1961-03-25","age":"","mstatus":"","insh":"10000100371","cliId":"","pno":2078372064,"cno":"","email":"tjznona@gmail.com","ename":"","eno":"","pphy":"HINE, JENNIFER L","ppno":2077984400,"pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"6 WESTERN AVE","madd2":"","madd3":"","mcity":"TOPSHAM","mstate":"ME","mzip":"04086","pcpfaxno":2077984018,"pcpnpi":1922031657,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7HT0DE1TF17","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1711","Z0000","G43909","M5450","F418","Z0101","G8918","I10","G4733","S0990XA","M25531","M79641","Z96653","M47812","M79671","M25569","M5410","Z09","M79672","Z96651","Z96652","M5116","Z1231","S59902A","Z471","E0590","E119","E785","Z794","M179","H8110","M542","S39012A","S43402A","Q845","M205X1","M205X2","M25522","M9901","M9902","M9903","M9900","S6991XA","E1042","B351","L858","Z1329","E559","I6523","E1165"],"date":["2023-01-26","2024-03-29","2024-03-29","2024-03-29","2024-03-29","2023-11-28","2023-01-24","2024-03-26","2023-01-24","2024-01-17","2024-01-18","2024-01-18","2024-06-06","2023-01-10","2024-07-26","2022-12-20","2022-12-20","2024-06-06","2024-07-26","2024-06-06","2024-06-06","2025-08-11","2024-03-26","2023-07-25","2024-06-06","2024-03-26","2024-03-26","2024-03-26","2023-12-05","2023-01-10","2023-01-19","2023-01-10","2023-10-20","2023-07-25","2024-01-03","2024-01-03","2024-01-03","2023-07-25","2023-11-29","2023-11-29","2023-11-29","2023-11-29","2024-01-18","2024-01-03","2024-01-03","2024-01-03","2024-03-26","2024-03-26","2023-01-19","2022-11-11"],"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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}