{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lloyd H Hart","gend":0,"currentgend":"","add":"22 CRESTVIEW","city":"Dayton","state":"ME","zip":"04005","dob":"1962-05-11","age":"","mstatus":"","insh":"10000018559","cliId":"","pno":"2079398309","cno":"2079398309","email":"declined@121624.com","ename":"","eno":"","pphy":"LEE, MAUREEN T","ppno":"2072863504","pcpadd":"57 BARRA RD,SUITE #1","pcpcity":"BIDDEFORD","pcpstate":"ME","pcpzip":"40059446","pcpcounty":"","pcpid":"","pcpname":"SEACOAST MEDICAL CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"22 CRESTVIEW","madd2":"","madd3":"","mcity":"Dayton","mstate":"ME","mzip":"04005","pcpfaxno":"2072863767","pcpnpi":"1275635781","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5PE6C41YH78","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","N400","E7800","Z136","Z1212","Z125","Z1331","Z1389","E119","F17200","I10","G4733","E1142","E1122","E1165","E7841","E669","Z23","D72829","Z0101","Z7189","R918","R059"],"date":["2024-06-11","2023-05-31","2023-05-31","2024-06-11","2024-06-11","2024-06-11","2024-06-11","2023-05-31","2024-06-11","2023-05-31","2023-09-26","2023-05-31","2024-06-25","2023-09-26","2023-09-28","2023-09-28","2023-09-28","2023-09-26","2024-05-07","2023-12-18","2024-02-27","2024-06-13","2024-06-13"],"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":[["","","Metformin Hcl Er","","","Select","Select",""],["","","Bupropion Hcl","300 MG","","Select","Select",""],["","","Epinephrine","0.3 MG","","Select","Select",""],["","","Januvia","","","Select","Select",""],["","","Amlodipine","10 MG","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Rosuvastatin","20 MG","","Select","Select",""],["","","Onetouch Verio","","","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":""}]}]}