{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jonathan L Thomas","gend":0,"currentgend":"","add":"19 NEWBURY NECK RD","city":"Surry","state":"ME","zip":"04684","dob":"1940-01-06","age":"","mstatus":"","insh":"00008302300","cliId":"","pno":2076672087,"cno":2074608454,"email":"JTHOMAS@PANAX.COM","ename":"","eno":"","pphy":"RENSENBRINK, KATHRYN","ppno":2076647780,"pcpadd":"Northern Light Primary Care Ellsworth,32 Resort Way","pcpcity":"Ellsworth","pcpstate":"ME","pcpzip":"04605","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"19 NEWBURY NECK RD","madd2":"","madd3":"","mcity":"Surry","mstate":"ME","mzip":"04684","pcpfaxno":2076647721,"pcpnpi":1124067194,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1AG7RY4VU79","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03116","K644","Z0000","I4719","I351","Z950","I480","I4729","F4321","D649","Z45018","R5383","S30862A","M7989","I739","Z139","H6123","R079","R161","B6000","G459","R600","R262","D696","R21","S81802A","R531","R7989","I4430","S81812A","W268XXA","Y9389","H40013","I878","H2513","H02831","H02834","R4781","R29818","K612","S20469A","N401","W57XXXA","Z7982","R29898","I2720","D6869","S8011XA","Y939","R1310","R6330","L820","E039","I639","W01198A","R0989","M25572","M79672","I4720","M26622","R0789","K0889","Z7901","Z5329","L089","S81812D","W2203XD","R350","Z5321","Z20822","E871","E860","M26629","H9201","B6001","Z4800","S40861A","Z8619","R2242","Z09","M19072","S80262A","I4710","H9113","S30861A","I4891","I509","G4733","D589","R5381","R5382","Z125","M25511","S299XXA","S20219A","R072","M25519","W19XXXA"],"date":["2024-01-28","2023-02-06","2024-01-02","2025-06-23","2025-01-27","2025-01-27","2024-01-02","2023-05-15","2022-12-13","2025-01-08","2025-07-16","2025-07-27","2024-05-17","2023-10-19","2025-08-01","2024-11-12","2023-08-11","2023-12-07","2024-09-27","2025-01-07","2024-10-09","2024-10-18","2024-10-09","2024-10-18","2024-06-17","2023-10-30","2025-07-19","2025-07-19","2023-12-07","2024-02-05","2023-10-03","2023-10-03","2025-03-24","2024-02-05","2025-03-24","2025-03-24","2025-03-24","2024-08-26","2024-08-26","2025-01-29","2023-06-12","2024-11-12","2024-05-17","2024-05-17","2024-08-26","2023-05-15","2023-12-04","2023-10-04","2023-10-30","2025-02-26","2024-12-11","2023-06-12","2025-06-23","2024-08-26","2024-08-26","2024-08-27","2023-10-08","2023-10-08","2022-11-14","2023-10-21","2023-11-26","2022-11-08","2025-04-16","2023-10-15","2024-01-28","2024-02-01","2024-01-29","2024-09-06","2024-08-25","2023-01-08","2024-09-25","2024-09-25","2023-10-21","2023-10-21","2024-09-25","2023-10-06","2023-08-11","2023-08-11","2023-10-10","2025-07-25","2023-10-10","2024-05-13","2025-04-16","2023-11-01","2024-06-17","2025-01-10","2024-10-16","2025-09-16","2024-10-16","2024-04-03","2025-07-21","2024-10-09","2022-08-12","2022-07-21","2022-07-18","2022-07-18","2022-07-21","2022-07-16"],"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":[["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ATOVAQUONE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","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":""}]}]}