{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Edith C Cotton","gend":1,"currentgend":"","add":"20 GRINDLE RD","city":"Swans Island","state":"ME","zip":"04685","dob":"1939-02-22","age":"","mstatus":"","insh":"10000008048","cliId":"","pno":2074796491,"cno":"","email":"declined@051523.com","ename":"","eno":"","pphy":"GREBLIUNAITE, RUTA","ppno":2079412373,"pcpadd":"EMMC Husson Family Medicine,302 Husson Ave Ste 2","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HUSSON FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"20 GRINDLE RD","madd2":"","madd3":"","mcity":"Swans Island","mstate":"ME","mzip":"04685","pcpfaxno":2079418803,"pcpnpi":1922487412,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9QA2RR6CT83","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N390","D649","Z0000","H35052","I10","Z5181","E785","I480","D696","R634","F329","M2550","M353","K5900","R413","M5450","R030","Z7901","Z79899","I083","R300","I2720","I350","D72819","R5383","R197","Z0101","H52203","M19042","M19041","M533","K5730","N281","Z98890","Z1231","H43813","N3941","N8110","N952","Z1272","M5136","M48061","M4807","I4891","M19049","G8929","R531","H35041","K115","H903","R194","L821","L814","D225","Z7189","L570","M5451","I4819","U071","E8342","D539","N200","Z7952","Z6825","K640","Z01411","K5790","K648","H3552","H26492","H3581"],"date":["2024-03-29","2025-01-14","2024-03-08","2025-07-17","2024-12-11","2023-06-01","2024-03-05","2025-07-03","2024-10-07","2024-03-01","2023-09-25","2024-03-05","2024-03-05","2025-04-17","2023-09-25","2023-05-23","2022-11-30","2022-12-29","2022-11-30","2025-07-03","2022-12-30","2025-07-03","2025-08-08","2022-10-19","2022-10-19","2023-10-27","2025-07-24","2025-07-24","2023-03-01","2023-03-01","2022-11-01","2022-10-03","2022-10-03","2023-04-24","2024-01-23","2022-10-18","2023-08-15","2023-08-15","2023-08-15","2023-08-15","2022-11-01","2022-11-01","2022-11-01","2023-12-05","2023-03-06","2025-04-23","2022-10-05","2025-07-17","2024-04-25","2024-11-04","2025-06-23","2023-10-11","2023-10-11","2023-10-11","2023-10-11","2023-10-11","2024-05-09","2025-04-10","2024-01-04","2023-10-23","2023-01-18","2025-04-17","2023-01-18","2022-09-30","2022-08-31","2022-08-08","2022-08-31","2022-08-31","2022-08-22","2022-08-22","2022-08-22"],"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":[["","","ELIQUIS","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","CLARITHROMYCIN","","","Select","Select",""],["","","SOTALOL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","WARFARIN 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":""}]}]}