{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donald E Bennett","gend":0,"currentgend":"","add":"241 KNOX ST","city":"RUMFORD","state":"ME","zip":"04276","dob":"1958-12-02","age":"","mstatus":"","insh":"10000118186","cliId":"","pno":2074916123,"cno":"","email":"firedtwocg@gmail.com","ename":"","eno":"","pphy":"BENNETT, BRITTANY A","ppno":2078242193,"pcpadd":"Bethel Family Health Center,32 Railroad St","pcpcity":"Bethel","pcpstate":"ME","pcpzip":"04217","pcpcounty":"","pcpid":"","pcpname":"BETHEL FAMILY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"241 KNOX ST","madd2":"","madd3":"","mcity":"RUMFORD","mstate":"ME","mzip":"04276","pcpfaxno":"","pcpnpi":1083227664,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7P99YC5QF42","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R911","Z85528","Z125","I2510","Z905","N62","M4726","M48061","M5116","M5117","T8130XA","C641","E119","M5451","L570","L820","L728","D229","L821","L578","M47816","M160","M47817","M4316","M5416","S46011D","J3489","M51369","M79672","Z0101","H5203","I10","I25118","R590","K5790","N400","K4020"],"date":["2025-06-10","2025-06-13","2025-03-10","2025-06-10","2025-06-10","2025-06-10","2025-05-05","2025-05-05","2025-05-05","2025-05-05","2025-06-13","2025-06-13","2025-07-02","2025-09-08","2025-05-12","2025-05-12","2025-05-12","2025-05-12","2025-05-12","2025-05-12","2025-10-27","2025-04-09","2025-04-09","2025-04-09","2025-05-05","2025-04-18","2025-04-09","2025-09-25","2025-07-02","2025-10-15","2025-10-15","2025-03-27","2025-03-14","2025-03-05","2025-03-05","2025-03-05","2025-03-05"],"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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","DEXCOM G6 TRANSMITTER","","","Select","Select",""],["","","DEXCOM G6 RECEIVER","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","DEXCOM G6 SENSOR","","","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":""}]}]}