{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Joan C Smith","gend":1,"currentgend":"","add":"841 BRIDGTON RD","city":"SEBAGO","state":"ME","zip":"04029","dob":"1938-03-16","age":"","mstatus":"","insh":"10000102198","cliId":"","pno":2076504472,"cno":"","email":"","ename":"","eno":"","pphy":"RIVARD, GARY S","ppno":2075243501,"pcpadd":"180 CHURCH HILL RD,STE 1","pcpcity":"LEEDS","pcpstate":"ME","pcpzip":"42633418","pcpcounty":"","pcpid":"","pcpname":"DFD RUSSELL MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"841 BRIDGTON RD","madd2":"","madd3":"","mcity":"SEBAGO","mstate":"ME","mzip":"04029","pcpfaxno":2076476015,"pcpnpi":1194801993,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9X93YV0KA98","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C189","R1909","I340","H2522","R0602","H401131","R918","R197","Z0000","I509","D649","C801","C3490","C180","I10","E538","R7303","H579","Z01818","Z09","K5730","Z85038","D509","R109","Z136","H2701","Z0101","H40053","K3189","G8918","I5032","I110","D500","K429","I517","G5601","G5603","G5602","D72829","J8489","M11231","R0603","Z13820","J302","Z741","M069","J449","Z23","J209","R6889","Z1211","H25813","H2589","H25811","H278","R600","M810"],"date":["2025-10-14","2024-10-31","2024-11-12","2023-03-21","2024-10-29","2024-11-21","2025-04-23","2024-09-18","2025-09-23","2024-11-05","2025-02-11","2025-04-23","2025-04-23","2024-11-29","2024-11-05","2023-03-29","2023-03-29","2023-03-21","2024-11-13","2025-10-21","2025-10-21","2025-10-21","2024-10-07","2024-12-12","2024-03-25","2023-02-28","2025-10-16","2023-05-23","2024-10-07","2024-11-29","2024-11-29","2024-11-29","2024-11-29","2024-09-12","2024-11-12","2025-06-25","2025-04-17","2025-07-30","2024-12-20","2024-07-23","2025-05-28","2024-09-11","2024-04-22","2023-10-03","2023-10-03","2023-02-27","2025-05-01","2024-10-31","2024-03-11","2023-06-26","2024-10-07","2023-01-04","2023-01-04","2023-01-24","2023-01-24","2024-09-12","2024-04-22"],"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":[["","","FUROSEMIDE","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","FORMOTEROL FUMARATE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","BUDESONIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","YUPELRI","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","LATANOPROST","","","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":""}]}]}