{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Todd K Bewig","gend":0,"currentgend":"","add":"31 BEAR SPRINGS LANE","city":"Surry","state":"ME","zip":"04629","dob":"1944-09-13","age":"","mstatus":"","insh":"00008198300","cliId":"","pno":2074607777,"cno":"","email":"tkbewig@gmail.com","ename":"","eno":"","pphy":"KOLISCH, ANITA D","ppno":2076647780,"pcpadd":"32 RESORT WAY,","pcpcity":"ELLSWORTH","pcpstate":"ME","pcpzip":"46051717","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2074607777,"add2":"","add3":"","madd1":"PO BOX 366","madd2":"","madd3":"","mcity":"Hancock","mstate":"ME","mzip":"04640","pcpfaxno":2076647721,"pcpnpi":1447283981,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8RY4J49YT82","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z5181","L570","R918","R319","I4891","Z7901","Z48816","T83031A","J189","R0789","Z139","R9720","H6122","R339","N400","Z0000","J449","I2720","K219","S0990XA","R399","J45909","D0439","E785","R17","S299XXA","S30863A","L905","N401","N3281","R079","E8342","Z8249","R911","C61","Z23","R55","I4720","D225","L578","L821","R310","R338","J984","W19XXXA","D6869","I4811","I2510","S70361A"],"date":["2025-05-22","2025-08-19","2025-02-19","2025-08-05","2025-08-27","2025-08-12","2024-03-26","2024-02-28","2023-09-06","2023-07-26","2024-05-23","2025-02-13","2023-12-05","2025-01-14","2025-04-18","2024-11-04","2024-12-04","2025-01-24","2024-11-04","2025-01-04","2024-03-13","2024-03-13","2023-09-20","2024-03-02","2023-08-09","2025-01-04","2023-04-25","2023-09-27","2025-01-14","2024-03-01","2023-07-30","2023-07-30","2023-07-30","2025-01-08","2024-12-04","2022-10-19","2025-01-24","2023-08-11","2022-11-16","2022-11-16","2022-11-16","2024-04-29","2024-04-29","2023-09-06","2025-01-03","2024-03-31","2024-12-23","2022-09-16","2022-07-03"],"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":[["","","AMOXICILLIN","","","Select","Select",""],["","","TETRACYCLINE HCL","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","SOD SULF-POTASS SULF-MAG SULF","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","EPINEPHRINE","","","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":""}]}]}