{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Diane L Davis","gend":1,"currentgend":"","add":"15 BRYANT DR","city":"BROOKLIN","state":"ME","zip":"04616","dob":"1955-02-26","age":"","mstatus":"","insh":"10000103611","cliId":"","pno":2074790159,"cno":"","email":"dlbent@hotmail.com","ename":"","eno":"","pphy":"CARTER, JACQUELINE L","ppno":2076647780,"pcpadd":"School House Health,21 School House Rd","pcpcity":"Orland","pcpstate":"ME","pcpzip":"04472","pcpcounty":"","pcpid":"","pcpname":"SCHOOL HOUSE HEALTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"15 BRYANT DR","madd2":"","madd3":"","mcity":"BROOKLIN","mstate":"ME","mzip":"04616","pcpfaxno":2077029194,"pcpnpi":1952560708,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2DX8GW2AC57","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K047","C441192","M25561","I10","G9389","G919","Z982","G4733","E039","M2550","D225","L821","L814","Z08","D485","M1711","C719","R220","Z1231","B070","Z0000","H40013","H2513","H04123","R21","L570","L820","L538","B078","R238","Z23","L918","C44319","G911","F325","M159","S30864A","Z1211","Z4541","Z780","M160","M1812","H5319","M19041","M19071","M19072","E7800","Z13820","J069","M25551"],"date":["2024-12-27","2024-07-02","2024-06-21","2025-03-10","2024-04-25","2024-04-25","2025-05-07","2025-06-16","2024-09-05","2023-02-01","2025-05-08","2025-05-08","2025-05-08","2025-05-08","2025-05-08","2025-04-30","2023-09-29","2025-05-07","2024-02-28","2024-03-22","2025-09-08","2025-08-21","2024-08-28","2024-08-28","2023-07-12","2023-01-13","2024-11-06","2024-11-06","2023-01-13","2023-01-13","2024-11-14","2024-05-06","2024-05-06","2025-05-07","2024-03-15","2024-03-15","2023-10-30","2024-04-16","2023-03-23","2023-12-26","2023-11-29","2023-02-01","2023-08-10","2023-02-01","2023-02-01","2023-02-01","2025-09-05","2023-12-26","2023-11-14","2025-08-11"],"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":{"comment":"","sub":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","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":""}]}]}