{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Bevley T Hawes","gend":1,"currentgend":"","add":"21 BOWDOIN ST","city":"WINTHROP","state":"ME","zip":"04364","dob":"1957-10-19","age":"","mstatus":"","insh":"10000098533","cliId":"","pno":"2074469496","cno":"","email":"declined@noemail.com","ename":"","eno":"","pphy":"RIVARD, GARY S","ppno":"2075243501","pcpadd":"180 CHURCH HILL RD,STE 1","pcpcity":"LEEDS","pcpstate":"ME","pcpzip":"42633418","pcpcounty":"","pcpid":"","pcpname":"DFD RUSSELL MEDICAL CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"21 BOWDOIN ST","madd2":"","madd3":"","mcity":"WINTHROP","mstate":"ME","mzip":"04364","pcpfaxno":"2076476015","pcpnpi":"1194801993","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6YX1NW5QV33","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z932","Z933","N824","Z08","Z85048","R748","D649","C20","Z98890","R609","N823","Z8742","Z923","C19","K632","Z09","Z01818","K460","Z0000","Z1231","Z780","Z0101","Z7689","E0500","Z13220","Z9221","Z432","K739","R300","Z980","R109","R188","J449","G8918","K7689","R112","Z978","Z4682","J9811","K469","Z452","R935","J439","I2510","K3189","N952","Z433","K6819","L598","Y842"],"date":["2024-01-05","2026-01-22","2025-02-05","2025-11-11","2025-06-18","2023-08-11","2023-07-20","2025-11-11","2023-10-26","2023-10-26","2025-06-09","2023-11-16","2025-06-18","2024-10-15","2024-03-29","2025-12-31","2025-04-02","2025-09-01","2026-02-09","2026-02-09","2026-02-09","2026-02-12","2025-04-28","2026-02-27","2026-02-27","2025-06-18","2026-01-20","2023-03-29","2025-08-27","2025-04-02","2025-09-01","2025-08-08","2023-03-29","2023-03-29","2023-03-29","2025-09-02","2025-09-02","2025-09-01","2025-09-01","2025-08-07","2025-08-07","2024-11-21","2025-11-11","2024-11-21","2025-05-05","2023-03-29","2025-07-16","2023-03-23","2023-01-17","2023-01-17"],"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":[["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","METRONIDAZOLE","500 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 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":""}]}]}