{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jane M Bennett","gend":1,"currentgend":"","add":"45 SPRUCE ST","city":"MILLINOCKET","state":"ME","zip":"04462","dob":"1959-06-27","age":"","mstatus":"","insh":"10000111296","cliId":"","pno":2072279584,"cno":2072279584,"email":"jmbslp1959@gmail.com","ename":"","eno":"","pphy":"LYBARGER, HOLLY L","ppno":2075282285,"pcpadd":"Katahdin Valley Health Center,30 Houlton St","pcpcity":"Patten","pcpstate":"ME","pcpzip":"04765","pcpcounty":"","pcpid":"","pcpname":"KATAHDIN VALLEY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 122","madd2":"","madd3":"","mcity":"MILLINOCKET","mstate":"ME","mzip":"04462","pcpfaxno":2075282595,"pcpnpi":1073769998,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4GY1U43UW95","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5450","Z20822","Z1231","J209","M810","E785","Z0101","H25813","H43811","G40209","Z08","Z8572","Z9484","Z9221","G629","K117","Z79899","I2510","C8510","Z923","S81802A","R569","Z0000","S50861A","C8590","I071","Z1211","J069"],"date":["2025-09-15","2024-01-05","2025-05-30","2024-06-27","2025-07-08","2025-01-17","2024-10-04","2024-10-04","2024-10-04","2024-09-17","2025-01-02","2025-01-02","2025-08-14","2025-01-02","2024-09-17","2024-09-17","2024-09-17","2025-02-10","2025-08-14","2025-08-14","2024-08-06","2025-01-08","2025-09-18","2024-07-05","2025-08-22","2025-01-17","2024-10-07","2024-06-19"],"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":[["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","LEVETIRACETAM","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","MIDODRINE HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","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":""}]}]}