{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Barry E Bunten","gend":0,"currentgend":"","add":"112 HORSESHOE VALLEY RD","city":"ROXBURY","state":"ME","zip":"04275","dob":"1958-03-26","age":"","mstatus":"","insh":"10000114063","cliId":"","pno":2072665886,"cno":"","email":"","ename":"","eno":"","pphy":"GOODMAN, MARGO B","ppno":2077952800,"pcpadd":"789 MINOT AVE,","pcpcity":"AUBURN","pcpstate":"ME","pcpzip":"42103924","pcpcounty":"","pcpid":"","pcpname":"ELSEMORE DIXFIELD FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 189","madd2":"","madd3":"","mcity":"ROXBURY","mstate":"ME","mzip":"04275","pcpfaxno":2077958490,"pcpnpi":1912268764,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7RW0A17YR20","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R400","I350","I739","G4733","F419","I352","I77810","Z95828","B379","M79672","I83029","E669","Z713","J069","R0609","R059","Z09","Z299","L03119","E6601","J209","Z1211","R0600","I77811","D120","K5730","K640","S99929A"],"date":["2025-08-29","2025-09-29","2024-10-16","2025-09-28","2025-08-27","2024-04-12","2024-04-12","2024-08-01","2024-10-16","2024-10-16","2024-10-16","2025-08-25","2025-09-11","2025-01-23","2025-09-15","2025-01-23","2025-09-29","2024-10-02","2024-10-22","2025-07-09","2024-10-31","2025-02-20","2025-09-15","2024-05-02","2025-02-20","2025-02-20","2025-02-20","2024-10-09"],"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":[["","","GAVILYTE-G","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","PREVNAR 20","","","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":""}]}]}