{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sylvia J Day","gend":1,"currentgend":"","add":"25 BROOK AVE","city":"BELFAST","state":"ME","zip":"04915","dob":"1945-08-13","age":"","mstatus":"","insh":"00008711600","cliId":"","pno":2072773248,"cno":2079446727,"email":"declined@121724.com","ename":"","eno":"","pphy":"VANDERMAST, DIANA M","ppno":2079437752,"pcpadd":"PO BOX 1129,","pcpcity":"GREENVILLE","pcpstate":"ME","pcpzip":"44411129","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE DOVER FOXCROFT","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"25 BROOK AVE","madd2":"","madd3":"","mcity":"BELFAST","mstate":"ME","mzip":"04915","pcpfaxno":2076952329,"pcpnpi":1669423349,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7T11GX1JD11","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E538","Z0101","K219","L570","B029","H04123","M8580","N6310","Z203","K0889","R079","S61250A","N6311","L299","R920","N6315","E785","M270","F4321","J449","R0602","I2510","M8589","Z780","Z0000","M546","R5383"],"date":["2025-09-08","2025-04-24","2025-07-23","2023-01-11","2025-10-07","2025-04-24","2023-09-21","2023-07-11","2023-09-22","2025-09-15","2025-06-24","2023-09-08","2023-07-21","2024-12-12","2023-07-21","2023-07-21","2024-03-08","2025-09-15","2023-07-25","2025-06-20","2025-06-20","2025-05-28","2022-10-05","2022-10-05","2022-09-20","2022-07-26","2022-07-26"],"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",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUZONE TRIVALENT 2024-2025","","","Select","Select",""],["","","FLUOCINOLONE ACETONIDE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}