{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jane L Ahlfeld","gend":1,"currentgend":"","add":"151 OQUNQUIT RD","city":"SOUTH BERWICK","state":"ME","zip":"03908","dob":"1957-11-04","age":"","mstatus":"","insh":"10000104935","cliId":"","pno":5085607949,"cno":"","email":"","ename":"","eno":"","pphy":"Adams, Todd","ppno":2076468386,"pcpadd":"YORK HOSPITAL INTERNAL MEDICINE OF YORK,277 POST RD","pcpcity":"MOODY","pcpstate":"ME","pcpzip":"04054","pcpcounty":"","pcpid":"","pcpname":"YORK HOSPITAL INTERNAL MEDICINE OF YORK","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"151 OQUNQUIT RD","madd2":"","madd3":"","mcity":"SOUTH BERWICK","mstate":"ME","mzip":"03908","pcpfaxno":2076412855,"pcpnpi":1427165778,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3Q24F29QD73","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E785","I3489","N200","H6982","Z0000","N202","I421","N1330","H25811","H25812","H25813","H2512","R011","H2511","I10","Z0101","R109","E7800","K8020","K5730","Z01419","Z1231","T148XXA","H5213","Z961","Z23","D225","L821","L814","Z7189","L570","D2262","D2261","D2272"],"date":["2025-04-29","2024-09-18","2025-05-28","2023-03-23","2025-04-17","2024-05-06","2024-01-29","2023-03-08","2024-03-07","2024-02-22","2023-12-19","2024-02-22","2023-07-12","2024-03-07","2024-03-07","2025-04-14","2025-05-28","2024-02-22","2024-04-03","2024-04-03","2024-10-21","2024-10-16","2024-11-22","2024-05-08","2024-05-20","2023-10-25","2024-10-16","2024-10-16","2024-10-16","2024-10-16","2024-10-16","2023-10-11","2023-10-11","2023-10-11"],"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":[["","","COMIRNATY 2024-2025","","","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":""}]}]}