{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Wade L Dow","gend":0,"currentgend":"","add":"6 DOW AVE","city":"BROOKLIN","state":"ME","zip":"04616","dob":"1944-07-31","age":"","mstatus":"","insh":"00008512200","cliId":"","pno":2073598901,"cno":"","email":"","ename":"","eno":"","pphy":"MURNIK, MICHAEL G","ppno":"","pcpadd":"Blue Hill Family Medicine,65 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":2073598901,"add2":"","add3":"","madd1":"6 DOW AVE","madd2":"","madd3":"","mcity":"BROOKLIN","mstate":"ME","mzip":"04616","pcpfaxno":2073743991,"pcpnpi":1972540110,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4TU7E31KK32","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R42","R110","M542","N400","N401","Z0000","K219","R1310","K2100","K2950","L820","H2511","G5601","R918","J9811","R21","L259","H04121","Z98890","B354","K31A11","K317","R2689","Z743","L309","Z0001","R1319","D0439","A6920","S40861A","W57XXXA","Z1211","L570","L578","R351","R9720","Z85528","G542","M7061","M7062","C649","Z905","H2512","Z961","H35363","Z96651","I129","U071","Z48811","Z8669","L821","D229","D1801","H52211","R079","D485","H01022","H01025","H11051","J8410","M25561","Z471"],"date":["2023-03-01","2023-03-01","2023-03-01","2024-11-12","2023-11-07","2025-04-16","2023-06-08","2023-06-08","2023-06-08","2023-06-08","2024-04-16","2023-12-05","2023-11-14","2023-10-31","2024-11-06","2023-01-12","2023-01-12","2025-03-17","2023-09-06","2023-11-03","2023-06-08","2023-06-08","2023-02-28","2023-02-28","2025-01-08","2024-03-29","2023-04-17","2024-12-05","2025-06-10","2025-06-10","2025-06-10","2023-04-17","2025-05-06","2024-04-16","2023-11-07","2023-11-07","2023-11-07","2023-11-14","2022-10-24","2022-10-24","2022-10-04","2022-10-04","2025-03-17","2024-11-06","2024-11-06","2022-10-24","2025-04-07","2023-03-18","2022-12-21","2022-12-21","2023-04-14","2023-04-14","2023-04-14","2023-12-13","2023-03-01","2024-11-18","2025-03-17","2025-03-17","2022-10-26","2022-09-07","2022-07-26","2022-06-20"],"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":[["","","CLONAZEPAM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","DOXAZOSIN MESYLATE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","LAGEVRIO (EUA)","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TRAMADOL HCL","","","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":""}]}]}