{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Barbara J Emerson","gend":1,"currentgend":"","add":"345 MAIN ST UNIT 211","city":"OLD TOWN","state":"ME","zip":"04468","dob":"1939-07-22","age":"","mstatus":"","insh":"00008192200","cliId":"","pno":2076591930,"cno":2079070870,"email":"","ename":"","eno":"","pphy":"KEITH, ALLISON C","ppno":2079412373,"pcpadd":"43 WHITING HILL RD,SUITE 300","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121005","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HUSSON FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"119 NORTHEAST 12TH ST","madd2":"","madd3":"","mcity":"OAK ISLAND","mstate":"NC","mzip":"28465","pcpfaxno":2079735042,"pcpnpi":1285013771,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3YE1V71TF06","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R3915","M25562","R058","M5459","R4701","I69920","M6281","R490","D72819","E039","S0990XA","W19XXXA","M8008XD","Z8781","M5137","M47816","M4317","M5450","Z0000","S22089D","G629","N1831","E063","M5187","I10","Z780","R1084","R0989","S3992XA","M810","E7800","I509","N390","R479","S22080A","W01198A","I6523","S22088A","R051","T148XXD","H903","R531","E559","E538","Q649","Z20822","W07XXXA","L740","S32000S","E875","Z7409","R269","I639","M5136","R6889","D3132","H6123"],"date":["2025-07-10","2025-06-05","2024-01-11","2024-03-28","2025-08-10","2025-08-10","2025-08-10","2025-08-15","2024-02-05","2025-10-01","2024-07-23","2024-07-23","2024-09-15","2024-09-19","2024-03-07","2024-03-07","2024-03-07","2024-04-10","2025-06-19","2024-10-31","2024-07-31","2024-07-31","2025-09-11","2024-05-15","2024-08-08","2023-08-14","2024-03-07","2025-09-18","2024-07-23","2024-09-04","2024-01-25","2025-10-02","2025-08-10","2025-08-10","2024-10-31","2024-07-23","2025-08-10","2024-07-23","2023-05-11","2024-07-24","2022-12-30","2025-08-10","2024-09-04","2023-07-27","2025-05-22","2024-01-11","2024-10-31","2025-08-07","2024-08-16","2023-07-27","2023-05-18","2023-06-15","2025-08-10","2024-04-15","2022-10-25","2022-10-11","2022-09-02"],"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":[["","","GABAPENTIN","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","LOPERAMIDE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}