{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nora Webber","gend":1,"currentgend":"","add":"696 SEBEC LAKE RD","city":"WILLIMANTIC","state":"ME","zip":"04443","dob":"1936-10-29","age":"","mstatus":"","insh":"00000007413","cliId":"","pno":2079973790,"cno":"","email":"eveb1956@aol.com","ename":"","eno":"","pphy":"ROOPE, SHELLY L","ppno":2078764811,"pcpadd":"22 HALEY CT,","pcpcity":"SANGERVILLE","pcpstate":"ME","pcpzip":"44793000","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE SANGERVILLE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2079973790,"add2":"","add3":"","madd1":"696 SEBEC LAKE RD","madd2":"","madd3":"","mcity":"WILLIMANTIC","mstate":"ME","mzip":"04443","pcpfaxno":2078764302,"pcpnpi":1487021259,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6P91MN0UJ95","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N3281","S39012A","I639","R42","Z87440","N390","R350","E1122","A499","R300","N898","B351","J9601","N179","R339","I083","I10","N1831","K529","S299XXA","B009","H527","E1142","E113293","Z09","R399","Z0000","K219","I129","K5730","K4090","E119","E785","M9900","Z0001","I080","I77810","B9620","R0600","R791","K521","R3915","M7989","W19XXXA","R112","S8011XA","W228XXA","J9811","M9902","I6782","R29810","M2042","M2041","M47816","R0602","L84","M779","L600","L853","E1140","E6601","F325"],"date":["2024-11-26","2022-12-14","2024-04-11","2024-05-07","2024-05-21","2025-04-19","2024-11-23","2025-02-18","2024-12-20","2025-04-19","2023-08-15","2025-08-19","2023-05-11","2023-05-11","2023-05-11","2023-05-10","2024-08-19","2025-04-01","2023-05-05","2023-07-01","2023-08-17","2024-06-26","2025-07-30","2024-06-26","2023-08-10","2024-11-12","2024-11-19","2023-07-13","2024-02-20","2023-05-09","2023-05-09","2024-02-22","2023-10-16","2023-04-10","2023-11-14","2024-04-12","2024-04-12","2023-05-09","2023-05-10","2023-05-10","2024-12-16","2023-10-16","2025-04-02","2025-04-02","2023-05-05","2025-04-02","2025-04-02","2023-05-09","2023-05-03","2024-04-12","2024-04-11","2025-07-30","2025-07-30","2022-12-14","2024-04-11","2022-07-28","2022-07-28","2022-07-28","2022-07-28","2022-07-11","2022-06-29","2022-06-29"],"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":[["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","SULFASALAZINE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","FREESTYLE TEST STRIPS","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","FREESTYLE LIBRE 2 READER","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","FREESTYLE FREEDOM LITE","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","ONETOUCH VERIO FLEX METER","","","Select","Select",""],["","","FREESTYLE LITE METER","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","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":""}]}]}