{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Raymond F Rancourt","gend":0,"currentgend":"","add":"290 AUGUSTA RD APT 8","city":"WINSLOW","state":"ME","zip":"04901","dob":"1934-02-06","age":"","mstatus":"","insh":"10000009296","cliId":"","pno":2076928903,"cno":"","email":"rayranc@yahoo.com","ename":"","eno":"","pphy":"SCHLEICH, DEBORAH M","ppno":2074657342,"pcpadd":"Northern Light Primary Care Clinton,1309 Main St","pcpcity":"Clinton","pcpstate":"ME","pcpzip":"04927","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE CLINTON","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"290 AUGUSTA RD APT 8","madd2":"","madd3":"","mcity":"WINSLOW","mstate":"ME","mzip":"04901","pcpfaxno":2078617056,"pcpnpi":1700331030,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4CY5KF9CX85","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H353230","H353210","M6281","M25569","Z0000","H538","R6889","T148XXA","R0600","H6121","H903","D696","H353231","Z0001","M79604","I350","I440","I444","E782","M79661","Z8673","I5030","R519","J449","I110","H35373","Z961","J40","J00","R600","M25571","M25572","I739","L539","H43813","H16142","I10","I088","Z7982","M1990","A6920","H5203","J45901","R0981","R059","J189","R0602","Z1152","H6123","M19071","M25561","Z96653","Z471","M25562","H353220","J45909","R351","I352","I2720","I77810","S41112A","Z09","Z96652","E785"],"date":["2025-08-26","2025-10-13","2025-06-27","2025-06-27","2024-08-06","2025-06-24","2023-04-28","2024-08-08","2025-02-25","2025-02-25","2023-10-19","2024-08-01","2025-06-24","2025-09-09","2025-01-09","2025-06-25","2025-06-25","2025-06-25","2025-06-25","2025-01-07","2025-01-04","2023-07-26","2024-03-14","2024-02-06","2024-12-17","2023-06-02","2025-06-24","2024-04-18","2024-04-18","2025-03-27","2023-01-24","2023-01-24","2025-02-06","2025-02-06","2025-06-02","2023-04-18","2025-04-17","2024-03-29","2025-01-21","2023-08-01","2023-08-25","2025-06-24","2023-11-18","2023-11-18","2023-12-05","2023-11-24","2023-11-24","2023-11-24","2022-12-05","2023-12-11","2025-03-27","2025-03-27","2025-03-27","2025-03-27","2022-11-09","2022-09-20","2022-09-20","2022-09-20","2022-09-20","2022-09-20","2022-08-06","2022-08-23","2022-08-23","2022-06-27"],"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":[["","","ADVAIR DISKUS","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","TRAMADOL HCL","","","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":""}]}]}