{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jeffery P Cypher","gend":0,"currentgend":"","add":"24 CYPHERS LN","city":"PORTER","state":"ME","zip":"04068","dob":"1953-04-09","age":"","mstatus":"","insh":"10000098535","cliId":"","pno":"2076254795","cno":"","email":"","ename":"","eno":"","pphy":"KITCHENS, CHRISTOPHER T","ppno":"","pcpadd":"70 MAIN ST,","pcpcity":"PORTER","pcpstate":"ME","pcpzip":"40683527","pcpcounty":"","pcpid":"","pcpname":"SACOPEE VALLEY HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"24 CYPHERS LN","madd2":"","madd3":"","mcity":"PORTER","mstate":"ME","mzip":"04068","pcpfaxno":"2076257820","pcpnpi":"1932410883","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3T22TV2WC11","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R932","K7689","D649","E039","I4892","Z7901","Z23","Z0000","I483","I10","E038","K7030","R29898","Z6830","Z6831","A6920","R7989","I358","H25811","H2512","H2511","C220","K319","Z8505","K2100","K222","K7460","K766","R413","H25812","D751","J45909","K769","Z0101","E8319","R790","Z1211","Z1212","H25813","K259","Z79899"],"date":["2023-04-06","2023-04-06","2023-04-06","2024-02-15","2025-07-08","2023-05-25","2023-06-16","2023-06-16","2023-06-16","2025-03-26","2023-11-09","2026-02-03","2024-02-15","2024-02-09","2024-01-12","2024-02-09","2025-03-21","2025-02-04","2026-01-15","2026-01-08","2026-01-15","2026-02-03","2025-03-26","2026-02-17","2025-03-26","2025-03-26","2026-01-06","2026-01-06","2025-07-21","2026-01-08","2025-08-07","2025-08-07","2025-08-07","2025-02-20","2025-07-08","2025-03-21","2025-03-05","2025-03-05","2025-11-24","2025-03-26","2025-01-20"],"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":[]},{"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":""}]}]}