{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Irene R Plummer","gend":1,"currentgend":"","add":"583 OCEAN POINT RD","city":"EAST BOOTHBAY","state":"ME","zip":"04544","dob":"1956-09-18","age":"","mstatus":"","insh":"10000111558","cliId":"","pno":2073509964,"cno":"","email":"ireneplummerart@gmail.com","ename":"","eno":"","pphy":"CLARK, MICHAEL E","ppno":2078615000,"pcpadd":"Maine Dartmouth Family Medicine,149 North St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"MAINE DARTMOUTH FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 78","madd2":"","madd3":"","mcity":"EAST BOOTHBAY","mstate":"ME","mzip":"04544","pcpfaxno":2078615101,"pcpnpi":1053387936,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1VJ2HW5JM85","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L814","D225","L578","Z872","D492","L820","H35372","M5450","R509","D709","R5383","E559","D0471","F329","M797","F419","F325","E039","G4700","M8580","H6121","H608X3","H3561","D235","M9903","M9905","M9902","M9901","G935","G3184","Z23","C44722","L570","D485","F331","M2550","L821","H3562"],"date":["2025-11-07","2025-11-07","2025-11-07","2025-11-07","2024-11-01","2024-01-19","2024-09-30","2024-03-05","2024-12-13","2025-06-12","2024-12-20","2025-04-01","2024-11-01","2024-04-05","2024-04-29","2024-07-25","2024-04-29","2025-04-01","2024-04-29","2024-04-29","2025-06-10","2025-06-10","2025-08-14","2024-01-26","2025-07-22","2025-04-23","2025-07-22","2025-07-22","2024-12-02","2024-12-02","2025-10-17","2024-12-06","2024-07-25","2024-07-25","2024-07-25","2024-04-26","2024-11-01","2025-01-06"],"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":[["","","PREVNAR 20","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","NOVAVAX COVID 2023-2024 (EUA)","","","Select","Select",""],["","","AFLURIA QUAD 2023-24 (3YR UP)","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","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":{"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":""}]}]}