{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Diane M Nardone Mcdonough","gend":1,"currentgend":"","add":"48 OLD POST RD","city":"KITTERY","state":"ME","zip":"03904","dob":"1956-12-26","age":"","mstatus":"","insh":"10000114234","cliId":"","pno":2076500785,"cno":"","email":"dianemcdonough@hotmail.com","ename":"","eno":"","pphy":"STUTTS, HANNAH B","ppno":6033661070,"pcpadd":"841 CENTRAL ST,","pcpcity":"FRANKLIN","pcpstate":"NH","pcpzip":"32352026","pcpcounty":"","pcpid":"","pcpname":"KITTERY FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"48 OLD POST RD","madd2":"","madd3":"","mcity":"KITTERY","mstate":"ME","mzip":"03904","pcpfaxno":6039342805,"pcpnpi":1477924199,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2H62GX8QY24","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","H2513","H401421","Z1211","G5601","G5603","G5602","H401423","M79642","M79641","R92333","D122","R921","Z800","D2271","Z1231","R920","L570","L814","L821","D2361","Z872","Z0100","M19042","N6032","H903","R922","M8588","Z780","R202","D485","M25572","G5732","G8929","K047","M8589","M65331","M151","M65322","M65321","M19041","M5416","M47816","M7672"],"date":["2025-10-16","2025-10-08","2025-04-15","2024-09-13","2024-08-14","2024-09-06","2024-08-14","2025-10-08","2025-10-14","2025-08-05","2025-06-23","2024-09-13","2025-06-23","2024-09-13","2024-05-02","2024-12-20","2025-01-02","2025-01-23","2025-01-23","2025-01-23","2025-01-23","2025-01-23","2025-10-27","2025-02-26","2025-01-02","2025-07-23","2024-06-17","2025-10-29","2025-10-29","2024-07-12","2024-05-02","2025-10-21","2025-10-21","2025-10-21","2025-08-16","2025-10-29","2025-11-18","2024-05-24","2025-11-18","2025-11-18","2025-11-18","2025-05-12","2025-05-12","2025-05-12"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","Select","Select",""],["","","BRIMONIDINE TARTRATE","","","Select","Select",""],["","","ADACEL TDAP","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","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":[]}},{"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":""}]}]}