{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"William H Allen","gend":0,"currentgend":"","add":"7 Cortland Cir","city":"Bangor","state":"ME","zip":"04401","dob":"1943-05-15","age":"","mstatus":"","insh":"00007783000","cliId":"","pno":2079418426,"cno":"","email":"peccavi@roadrunner.com","ename":"","eno":"","pphy":"Ronco, Paul G","ppno":2079476141,"pcpadd":"43 Whiting Hill Rd,Suite 300","pcpcity":"Brewer","pcpstate":"ME","pcpzip":"44121005","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2079418426,"add2":"","add3":"","madd1":"7 Cortland Cir","madd2":"","madd3":"","mcity":"Bangor","mstate":"ME","mzip":"04401","pcpfaxno":2079476720,"pcpnpi":1033152582,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6N83TX8MA87","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R2689","Z0101","F419","F411","I10","Z87891","E785","H5203","G250","H40013","F331","I2720","G4733","R531","F330","Z13220","B351","R262","U071","F32A","G4700","B078","D225","L821","L814","Z0000","G629","H2511","Z7189","L309","H52223","L2089","D485","I7121","H903","M549","G608","L02211","Z79899","R5383","E669","I7140","Z872","I77810","E6601","R251","R29898","R059","Z09","Z96643","L308","I77819","I517","R7989","Z6835","H61002","R2681","I4510","I491","H2513","R778","Z9989","Z8616"],"date":["2024-11-20","2024-09-30","2025-04-22","2025-03-13","2023-11-15","2023-09-26","2023-11-15","2024-03-26","2024-11-20","2025-04-15","2024-08-29","2024-10-21","2025-05-28","2023-01-28","2025-03-13","2023-09-29","2025-06-09","2025-06-09","2023-01-29","2023-12-28","2023-12-28","2025-04-03","2025-04-03","2025-04-03","2025-04-03","2025-04-24","2025-05-12","2024-02-26","2024-09-26","2024-09-26","2024-09-30","2023-09-21","2025-03-14","2024-10-21","2024-11-06","2022-12-06","2024-05-06","2024-12-30","2025-03-13","2025-04-24","2025-04-24","2023-04-06","2022-09-15","2023-03-22","2023-03-22","2022-11-30","2022-11-30","2023-02-08","2023-07-20","2023-07-20","2024-09-26","2023-01-30","2023-01-30","2023-01-30","2023-02-13","2025-03-14","2023-01-28","2023-01-30","2023-01-30","2024-01-16","2023-01-29","2023-01-29","2023-02-08"],"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":[["","","PRIMIDONE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","DILTIAZEM HCL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","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":""}]}]}