{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Betsy B Newman","gend":1,"currentgend":"","add":"101 FERNALD RD","city":"NEWPORT","state":"ME","zip":"04953","dob":"1958-04-17","age":"","mstatus":"","insh":"10000106375","cliId":"","pno":2074166046,"cno":"","email":"betsybelindanewman@yahoo.com","ename":"","eno":"","pphy":"ARCEO, REYNALDO A","ppno":2074875154,"pcpadd":"470 SOMERSET AVE,","pcpcity":"PITTSFIELD","pcpstate":"ME","pcpzip":"49674928","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE PITTSFIELD","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"101 FERNALD RD","madd2":"","madd3":"","mcity":"NEWPORT","mstate":"ME","mzip":"04953","pcpfaxno":2074873158,"pcpnpi":1144347196,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9HN7GM8UK37","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R197","N202","M25571","R079","R002","K222","E785","M79671","M7731","S93602A","M810","M25572","M79672","M7732","Z0000","M7989","M25511","N200","Z90710","K820","K7689","H40013","Z1231","R1011","M60871","R42","K317","R609","R1310","Z0100","K224","K319","K219","I788","L920","Z7189","L821","B001","D225","L814","B009","K625","R233","M19071","Z1211"],"date":["2024-03-16","2023-07-08","2023-07-28","2023-05-12","2023-05-12","2023-05-12","2023-05-12","2023-05-05","2023-04-16","2023-04-16","2023-04-16","2023-04-16","2023-04-16","2023-04-16","2024-11-15","2023-04-16","2023-04-16","2023-07-08","2023-07-08","2023-07-08","2023-07-08","2024-03-15","2023-08-04","2024-03-29","2023-04-21","2024-11-22","2025-08-22","2023-05-05","2024-09-20","2023-06-02","2025-07-21","2025-08-22","2025-08-22","2024-07-19","2024-07-19","2025-07-25","2025-07-25","2024-11-29","2025-07-25","2025-07-25","2025-08-07","2025-07-26","2023-09-22","2023-05-05","2025-07-13"],"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":[["","","ACYCLOVIR","","","Select","Select",""],["","","VALACYCLOVIR","","","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":{"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":""}]}]}