{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dorothy E Hagar","gend":1,"currentgend":"","add":"114 ALLEN RD","city":"Lovell","state":"ME","zip":"04051","dob":"1937-01-06","age":"","mstatus":"","insh":"10000041458","cliId":"","pno":"2072560120","cno":"","email":"","ename":"","eno":"","pphy":"COADY, KATHERINE M","ppno":"2076479021","pcpadd":"North Bridgton Family Practice,14 Wyonegonic Rd","pcpcity":"Bridgton","pcpstate":"ME","pcpzip":"04009","pcpcounty":"","pcpid":"","pcpname":"NORTH BRIDGTON FAMILY PRACTICE AND WALK IN CLINIC","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"114 ALLEN RD","madd2":"","madd3":"","mcity":"Lovell","mstate":"ME","mzip":"04051","pcpfaxno":"","pcpnpi":"1285010371","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1MT6A42MT56","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z7901","I4891","Z739","I10","R4189","E785","R319","R300","S01111A","R410","S79911A","S79921A","S0990XA","B351","S8001XA","M25551","S199XXA","L602","M79674","M79675","R531","R4182","M25561","E039","S8011XA","F0390","Z23","Z0389","H26492","H26493","H353132","S8991XA","Z7689","I160","S81811A","R5381","M79661","Z9989","S0003XA","G309","M1611","M47816","R262"],"date":["2025-09-19","2026-01-13","2025-03-01","2026-02-04","2024-07-24","2024-03-18","2024-05-28","2026-02-24","2025-03-30","2026-01-10","2025-04-21","2025-04-21","2025-09-17","2026-03-05","2025-03-30","2025-03-27","2025-03-30","2026-03-05","2026-03-05","2026-03-05","2025-04-21","2026-01-10","2023-03-20","2025-04-21","2025-04-10","2026-01-13","2024-11-20","2026-01-13","2025-05-23","2025-04-07","2025-04-07","2025-03-30","2025-12-03","2026-01-11","2024-10-20","2026-01-15","2024-10-20","2025-09-05","2025-09-17","2025-09-17","2025-02-03","2025-02-03","2026-01-13"],"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":[]},{"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":""}]}]}