{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Forest K Moors","gend":0,"currentgend":"","add":"63 CEDAR ST","city":"Old Town","state":"ME","zip":"04468","dob":"1944-05-05","age":"","mstatus":"","insh":"10000009095","cliId":"","pno":2074043281,"cno":"","email":"FKMOORS@YAHOO.COM","ename":"","eno":"","pphy":"KANUMALLA, RAGHU","ppno":2079890550,"pcpadd":"Northern Light Primary Care Brewer,234 State St","pcpcity":"Brewer","pcpstate":"ME","pcpzip":"04412","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"63 CEDAR ST","madd2":"","madd3":"","mcity":"Old Town","mstate":"ME","mzip":"04468","pcpfaxno":2079890551,"pcpnpi":1497313696,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6W63QX6AR08","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J069","H109","Z7982","L299","R55","L989","D849","W1839XA","Y92480","H6691","I161","T8149XA","E11319","Z98890","I6523","I10","E119","T8141XD","L309","I25119","C44529","N1830","C44722","R918","I25110","C44629","L820","R208","L298","L538","L2089","H40013","H5213","H52223","H524","H2513","H35033","K5090","L570","C44729","R197","C44622","C4442","I2510","S76011A","X58XXXA","N4289","N401","R002","D485","N400","R58","Z79899","D225","L821","L814","B078","A072","M1611","Z08","I7140","Z85828","R0609","R0789","R911","K8020","K760","Z7189","K5730","D044","C760","Z0000","M25571","E785","E039","Z01812","K529","K4090","N179","C44329","M549","Z86711","Z7902","R001","C44319","I6529","D72829","J432","R9720","R9389","D0439","D0461","A499","H6980","L578","E1122","C44219","M25511","R42","R634","R059","R0989"],"date":["2023-06-04","2023-06-04","2024-12-27","2024-07-26","2023-11-02","2023-08-08","2023-08-08","2023-10-25","2023-10-25","2023-11-02","2025-10-23","2023-11-02","2025-04-29","2023-04-10","2024-10-30","2023-04-10","2025-03-19","2024-12-20","2024-12-20","2025-11-07","2025-11-05","2025-04-29","2025-11-19","2025-02-25","2025-03-24","2025-11-19","2025-04-16","2025-04-16","2024-08-20","2025-04-16","2024-11-06","2025-03-19","2025-03-19","2025-03-19","2025-03-19","2025-03-19","2025-03-19","2024-12-05","2025-07-16","2025-03-05","2024-10-17","2025-03-28","2025-08-26","2025-03-17","2023-11-30","2023-11-30","2024-04-10","2024-04-10","2024-04-03","2025-11-19","2024-05-09","2024-05-08","2024-12-05","2025-07-16","2025-07-16","2025-07-16","2025-07-16","2024-06-13","2023-11-30","2025-04-16","2025-02-25","2024-05-07","2024-12-20","2024-12-20","2024-05-07","2023-10-25","2023-10-25","2024-03-27","2025-05-20","2024-01-24","2025-08-26","2025-01-21","2023-08-23","2024-01-05","2024-01-05","2025-08-14","2025-05-20","2025-05-20","2025-10-31","2023-11-20","2024-12-27","2024-12-27","2024-12-27","2023-10-24","2024-06-25","2025-03-06","2023-10-24","2023-11-22","2024-10-17","2024-04-23","2023-02-13","2023-02-13","2024-12-18","2023-04-27","2023-10-11","2022-10-05","2022-10-04","2022-09-07","2022-07-22","2022-07-22","2022-07-06","2022-07-06"],"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":[["","","DOXAZOSIN MESYLATE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","DILTIAZEM HCL","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","TACROLIMUS","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","AMMONIUM LACTATE","","","Select","Select",""],["","","MERCAPTOPURINE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","POLYMYXIN B SUL-TRIMETHOPRIM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","ERYTHROMYCIN","","","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":""}]}]}