{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Charles E Prince","gend":0,"currentgend":"","add":"49 PARTRIDGE LN","city":"BERWICK","state":"ME","zip":"03901","dob":"1944-05-18","age":"","mstatus":"","insh":"10000128300","cliId":"","pno":"6038662924","cno":"","email":"","ename":"","eno":"","pphy":"HASSETT, WILLIAM E","ppno":"6037423174","pcpadd":"Dover Family Practice, 10 Members Way Ste 203","pcpcity":"Dover","pcpstate":"NH","pcpzip":"03820","pcpcounty":"","pcpid":"","pcpname":"WHP DOVER FAMILY PRACTICE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"49 PARTRIDGE LN","madd2":"","madd3":"","mcity":"BERWICK","mstate":"ME","mzip":"03901","pcpfaxno":"6037421855","pcpnpi":"1386683001","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9PU3YE4VC75","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H547","H2511","I480","H43813","H25811","H25813","H401231","Z8669","H25812","I495","Z23","Z961","H5703","H40011","H5213","H5051","L570","R739","M1611","E782","R351","H2512"],"date":["2025-10-16","2025-11-06","2025-08-05","2025-12-16","2025-11-06","2025-08-25","2025-08-25","2025-12-16","2025-11-20","2026-03-04","2025-11-19","2026-01-08","2025-11-20","2025-12-19","2025-12-19","2025-12-19","2025-08-28","2025-09-30","2025-06-30","2025-12-30","2025-06-26","2025-11-20"],"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":{"comment":"","sub":[["","","Atorvastatin","40 MG","","Select","Select",""],["","","Amlodipine","2.5 MG","","Select","Select",""],["","","Eliquis","","","Select","Select",""],["","","Sodium Fluoride 5000 Ppm (Spearmint)","","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Metoprolol Tart","25 MG","","Select","Select",""],["","","Tamsulosin","0.4 MG","","Select","Select",""],["","","Denta 5000 Plus","","","Select","Select",""],["","","Hydrocodone\/Acetaminophen","5\/325 MG","","Select","Select",""],["","","Latanoprost 0.005 % Ophth Sol B&L","","","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":""}]}]}