{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kim S Hanscom","gend":1,"currentgend":"","add":"154 DOUGHTY RD","city":"Bowdoin","state":"ME","zip":"04287","dob":"1956-05-04","age":"","mstatus":"","insh":"10000085906","cliId":"","pno":"2076073601","cno":"","email":"","ename":"","eno":"","pphy":"RIEHL, JENNIFER M","ppno":"2074067600","pcpadd":"Mid Coast Medical Group Topsham Internal Medicine,1 Wellness Way Ste A","pcpcity":"Topsham","pcpstate":"ME","pcpzip":"04086","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"154 DOUGHTY RD","madd2":"","madd3":"","mcity":"BOWDOIN","mstate":"ME","mzip":"04287","pcpfaxno":"2074067601","pcpnpi":"1700897618","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8T28YF9WA51","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K625","Z0000","M3500","E6601","Z6836","Z1231","R160","R7989","K760","Z9049","J3489","G479","K635","K5730","K641","H04123","D492","D123","F320","F5101","R109","R102","Z8041","N854","M47816","M5136","M5450","M3501","Z6834","M1611","R1031"],"date":["2023-06-22","2023-06-22","2023-06-22","2024-05-14","2023-06-22","2023-07-17","2024-05-20","2023-07-17","2023-07-17","2023-07-17","2023-10-25","2023-10-25","2023-10-30","2024-05-19","2023-10-30","2023-11-14","2023-11-14","2023-10-30","2024-01-31","2024-01-31","2024-05-15","2024-05-15","2024-05-19","2024-05-15","2024-05-15","2024-05-15","2024-05-15","2024-05-14","2024-05-14","2024-05-15","2024-05-19"],"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":[["","","Mupirocin 2 % Ointment Padagis","","","Select","Select",""],["","","Sertraline","25 MG","","Select","Select",""],["","","Clotrim\/Betameth Diprop 1\/0.05 % Cream Fou","","","Select","Select",""],["","","Atorvastatin","80 MG","","Select","Select",""],["","","Losartan","100 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Temazepam","15 MG","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Omeprazole","20 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":""}]}]}