{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Bonnie M Riddle","gend":1,"currentgend":"","add":"751 MAIN STREET UNIT 78","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1944-06-10","age":"","mstatus":"","insh":"10000052178","cliId":"","pno":"2077670715","cno":"","email":"bjriddle78@gmail.com","ename":"","eno":"","pphy":"SONTI, SMITA","ppno":"2077998596","pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"751 MAIN STREET UNIT 78","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":"2078287850","pcpnpi":"1992904080","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2D07XX5KG44","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","C50911","M810","N951","Z170","Z23","L821","L570","H40013","M419","C50919","M549","M47816","R921","Z98890","Z79811","Z0101","H40023","Z08","Z853","Z87891","Z923","D0361","R918","C3490","J439","K449","K5730","R609","R1031","J189","R519","J029","C3431","N6310","C3432","J479","I700","I771","Z48815","D125","K649","D485","K3580","K3532","C7801","C801","Z0389","D123","K648","J984","L720","M8580","H401131","H353132","K6389","L728","Z79818"],"date":["2025-07-21","2025-07-28","2023-05-08","2023-05-08","2025-07-21","2025-10-02","2024-04-01","2025-01-06","2024-05-03","2023-11-06","2023-11-06","2023-11-06","2023-11-06","2024-12-27","2023-12-27","2024-10-21","2024-03-28","2024-03-28","2025-09-12","2025-05-22","2025-05-22","2025-05-22","2026-02-10","2025-05-12","2025-07-18","2025-07-18","2025-09-22","2025-09-22","2025-09-22","2025-09-22","2024-11-08","2024-11-08","2024-11-08","2025-12-12","2025-09-12","2025-07-28","2024-11-25","2024-11-25","2024-11-08","2025-10-08","2025-05-09","2025-05-09","2026-01-12","2025-09-22","2025-09-22","2025-12-05","2025-12-05","2025-04-30","2025-05-09","2025-05-09","2025-05-12","2026-01-12","2024-10-21","2024-10-16","2024-10-16","2025-05-09","2026-01-12","2025-07-28"],"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","","","Select","Select",""],["","","Comirnaty 2023-2024","","","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":""}]}]}