{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan V Breau","gend":1,"currentgend":"","add":"213 OAK ST","city":"RUMFORD","state":"ME","zip":"04276","dob":"1957-11-24","age":"","mstatus":"","insh":"10000106924","cliId":"","pno":2074231125,"cno":"","email":"suevbre@gmail.com","ename":"","eno":"","pphy":"KING, JESSICA S","ppno":2075624226,"pcpadd":"Elsemore Dixfield Family Medicine,146 Weld St","pcpcity":"Dixfield","pcpstate":"ME","pcpzip":"04224","pcpcounty":"","pcpid":"","pcpname":"ELSEMORE DIXFIELD FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"213 OAK ST","madd2":"","madd3":"","mcity":"RUMFORD","mstate":"ME","mzip":"04276","pcpfaxno":5188242388,"pcpnpi":1649615923,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2KF7VC4XQ74","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1231","K8012","G4733","R1031","M5451","M1611","M25512","H04123","H26491","N3281","R350","N3941","M25551","M75102","M79662","M75112","M7582","M79671","I10","M722","Z09","R1030","R110","Z9049","G4730","Z0101","H5213","H3561","M79672","M7732","R102","Z0000","K37","K3530","E7800","M25552","H04129","R400","S96822D","R1011","K8020","R7303","S96811A","H5212","K3580","R3915"],"date":["2025-09-04","2025-01-03","2025-11-10","2025-09-10","2025-10-01","2023-10-24","2023-12-05","2024-03-21","2024-04-18","2025-10-22","2024-08-12","2024-08-12","2023-10-10","2023-10-10","2023-05-02","2023-05-23","2023-05-23","2023-06-20","2025-09-10","2023-09-08","2025-09-19","2025-09-10","2025-09-10","2025-10-02","2025-03-31","2025-09-17","2025-09-17","2025-09-17","2023-05-02","2023-05-02","2024-07-30","2025-05-15","2025-09-10","2025-09-11","2024-01-19","2025-05-06","2024-12-18","2024-10-07","2023-08-11","2024-11-11","2024-11-25","2023-09-08","2023-05-19","2024-09-12","2025-09-10","2023-11-03"],"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}