{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Martin H Shaw","gend":0,"currentgend":"","add":"66 COUNTRY CLUB RD","city":"Mars Hill","state":"ME","zip":"04758","dob":"1938-06-07","age":"","mstatus":"","insh":"10000007683","cliId":"","pno":"","cno":2072275957,"email":"shawjoan882@gmail.com","ename":"","eno":"","pphy":"MCFADGEN, ROBERT L","ppno":2077643142,"pcpadd":"TAMC Family Practice and Internal Medicine,23 North St Ste 4","pcpcity":"Presque Isle","pcpstate":"ME","pcpzip":"04769","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE PRESQUE ISLE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 1183","madd2":"","madd3":"","mcity":"Mars Hill","mstate":"ME","mzip":"04758","pcpfaxno":2077608170,"pcpnpi":1689025959,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5N82NT8HW94","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K921","Z08","Z8551","K5730","K449","Z87891","R896","E039","Z79899","R5383","I7142","I7140","C679","L570","R410","L821","L905","Z85828","Z0000","N35919","N12","R195","H40013","H353131","H35373","H04123","R350","Z87440","Z8619","Z1331","Z98890","Z23","Z09","Z8679","R531","H6123","Z87448","D492","Z79890","N3289","N400","I10","U099","R300","M5450","A419","E7800","G4700","M79605","R6889","Z974","H6122","Z48810","Z961"],"date":["2022-12-27","2025-05-06","2025-05-06","2022-12-09","2022-12-09","2023-04-11","2025-05-06","2025-04-01","2023-04-11","2025-07-04","2022-11-23","2022-11-25","2024-11-05","2025-06-05","2025-07-04","2025-06-05","2025-06-05","2025-06-05","2024-09-18","2023-05-09","2024-12-10","2022-11-22","2025-07-23","2025-07-23","2025-07-23","2025-07-23","2024-12-23","2024-12-23","2024-12-23","2023-09-20","2023-09-20","2024-10-30","2023-10-31","2023-02-02","2023-04-25","2025-03-17","2023-10-31","2025-04-01","2025-04-01","2025-05-06","2025-05-06","2023-09-20","2023-04-07","2023-05-31","2023-04-07","2024-12-10","2024-09-18","2023-04-11","2023-04-11","2023-03-30","2025-06-11","2024-10-28","2022-07-13","2022-07-13"],"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":[["","","FLUOROURACIL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","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":""}]}]}