{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Benjamin Pearson","gend":0,"currentgend":"","add":"216 ROSS RD","city":"DURHAM","state":"ME","zip":"04222","dob":"1954-06-08","age":"","mstatus":"","insh":"10000068488","cliId":"","pno":"2072725723","cno":"2072725723","email":"pearsonben@comcast.net","ename":"","eno":"","pphy":"UDUEBOR, MIRIAM","ppno":"","pcpadd":"Martins Point Health Care,\t114 Bath Rd","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"216 ROSS RD","madd2":"","madd3":"","mcity":"DURHAM","mstate":"ME","mzip":"04222","pcpfaxno":"2076267401","pcpnpi":"1477120590","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7VA3H67GY70","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":["R6889","R9720","N401","E785","M19012","M25512","N4289","M25511","M13811","C61","R195","R194","H04123","L570","L814","Z85828","L578","K30","I10","R197","Z01818","R310","R339","Z01810","I440","R001","R9431","M13819","K219","N402","R4182","Z4789","K3189","K635","K5730","D122","R198","Z1211","K580","Z79899","Z0000","N529","Z0101","M9907","H2513","H35373","H353110"],"date":["2023-08-16","2024-02-08","2023-04-28","2024-02-08","2023-11-09","2024-07-08","2023-06-12","2023-06-14","2023-06-14","2024-07-09","2023-09-23","2023-12-16","2023-08-16","2023-09-18","2023-09-18","2023-09-18","2023-09-18","2023-10-02","2024-02-08","2023-09-23","2023-09-22","2023-10-11","2023-10-11","2023-10-03","2023-10-03","2023-10-03","2023-10-03","2023-10-25","2023-10-09","2023-10-09","2023-11-09","2023-11-20","2023-11-28","2023-11-28","2023-11-28","2023-11-28","2023-12-14","2023-12-14","2024-01-11","2024-02-08","2024-02-08","2024-07-09","2024-03-27","2024-07-08","2024-07-01","2024-07-01","2024-07-01"],"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":[["","","Prednisolone Ace 1 % Ophth Susp Pacific","","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Losartan","25 MG","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Doxycycline Hyclate","20 MG","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","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":""}]}]}