{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Theresa A Bell","gend":1,"currentgend":"","add":"56 BERIBIEAU DR APT 103","city":"BRUNSWICK","state":"ME","zip":"04011","dob":"1925-06-06","age":"","mstatus":"","insh":"10000046450","cliId":"","pno":"2076153245","cno":"","email":"","ename":"","eno":"","pphy":"DAVIS, MARY E","ppno":"2077955700","pcpadd":"12 HIGH ST,STE 400","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407634","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"655 MAIN RD \/ D CROMWELL","madd2":"","madd3":"","mcity":"WESTPORT ISLAND","mstate":"ME","mzip":"04578","pcpfaxno":"2077955727","pcpnpi":"1215917919","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3RH3G42NY13","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","F423","F39","R413","M549","R7401","M5450","M47816","M5136","Z043","I77810","S32039A","K769","S2241XA","M25551","K219","M160","R5381","G9340","F0390","M4856XA","E875","S22080D","S32032A","S32020D","F419","E876","S2232XA","R0781","R0782","J0130","R9089","I672","S2242XA","S2249XA","A000","I517","Z9181","B351","M2042","M2041","M79675"],"date":["2023-11-13","2023-04-24","2023-04-24","2024-04-10","2023-06-06","2023-06-06","2023-07-24","2023-06-06","2023-06-05","2024-06-07","2023-06-06","2023-06-06","2023-06-06","2023-06-06","2023-06-05","2023-06-05","2023-06-05","2023-06-09","2023-06-09","2023-10-12","2023-06-06","2023-06-06","2023-06-27","2023-06-23","2023-06-27","2023-07-24","2023-07-24","2024-06-07","2024-06-09","2024-06-09","2024-06-07","2024-06-07","2024-06-07","2024-06-09","2024-06-09","2024-06-16","2024-06-07","2024-06-18","2024-05-03","2024-05-03","2024-05-03","2024-05-03"],"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":[["","","Ondansetron","4 MG","","Select","Select",""],["","","Memantine","5 MG","","Select","Select",""],["","","Lisinopril","10 MG","","Select","Select",""],["","","Potassium Cl","20 MEQ","","Select","Select",""],["","","Sertraline","25 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Donepezil","10 MG","","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":""}]}]}