{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sandra B Hill","gend":1,"currentgend":"","add":"8 SALT POND RD","city":"BLUE HILL","state":"ME","zip":"04614","dob":"1941-01-10","age":"","mstatus":"","insh":"00008498800","cliId":"","pno":2073745063,"cno":"","email":"","ename":"","eno":"","pphy":"LESKO, LISA A","ppno":2073742311,"pcpadd":"Blue Hill Family Medicine,57 Water St","pcpcity":"Blue Hill","pcpstate":"ME","pcpzip":"04614","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BLUE HILL","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2073745063,"add2":"","add3":"","madd1":"8 SALT POND RD","madd2":"","madd3":"","mcity":"BLUE HILL","mstate":"ME","mzip":"04614","pcpfaxno":2073742618,"pcpnpi":1720022866,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5D63FC7XY74","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E109","S32009D","E113299","I10","E113293","H3509","H35033","Z23","S32001A","K5900","Y999","R109","M47816","E113393","H40013","H33313","H43393","H33311","S32012A","E039","S32011A","R110","I2510","M8008XA","M5450","N6322","E10649","N6489","M810","R21","Z13820","Z1231","Z961","M5431","R269","N6002","E1065","E7800","M8008XD","M4856XD","R921","M48061","M5126","M47817","E103393","H34823","H43813","N6320","E119","Z0000","L602","R42","Z9989","R55","R531","E861"],"date":["2025-07-17","2023-03-10","2024-12-30","2025-05-23","2025-05-07","2025-05-07","2025-05-07","2025-06-04","2023-03-08","2023-03-08","2023-03-05","2023-03-05","2023-04-10","2025-07-09","2025-07-09","2024-06-26","2025-01-07","2024-06-26","2023-03-06","2023-03-08","2023-03-06","2023-03-06","2023-03-06","2023-03-05","2023-03-02","2025-02-26","2024-04-19","2025-02-26","2025-08-13","2024-08-05","2025-07-22","2023-08-09","2025-01-07","2023-06-15","2023-12-12","2025-02-26","2024-08-16","2024-01-12","2023-04-10","2023-04-10","2023-08-09","2023-04-10","2023-04-10","2023-04-10","2023-11-08","2022-11-09","2023-11-08","2024-02-28","2023-11-07","2025-08-06","2022-09-16","2022-09-03","2022-09-03","2022-09-03","2022-09-03","2022-09-03"],"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":[["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","FREESTYLE LIBRE 3 READER","","","Select","Select",""],["","","FREESTYLE PRECISION NEO","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","FREESTYLE LIBRE 2 READER","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","VALSARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","UNIFINE PENTIPS PLUS","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","GVOKE HYPOPEN 2-PACK","","","Select","Select",""],["","","TRUEPLUS LANCETS","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","ULTRA-FINE MICRO PEN NEEDLE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","FREESTYLE LANCETS","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}