{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ronald L Brasslett","gend":0,"currentgend":"","add":"59 OLD TOWN RD","city":"HUDSON","state":"ME","zip":"04449","dob":"1943-03-03","age":"","mstatus":"","insh":"10000011186","cliId":"","pno":2079070518,"cno":"","email":"RLBMB@ROADRUNNER.COM","ename":"","eno":"","pphy":"WAGNER, KRISTEN M","ppno":2075644464,"pcpadd":"1675 LEAHY ST,SUITE 315A","pcpcity":"MUSKEGON","pcpstate":"MI","pcpzip":"49442550","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE CORINTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2079245708,"add2":"","add3":"","madd1":"59 OLD TOWN RD","madd2":"","madd3":"","mcity":"HUDSON","mstate":"ME","mzip":"04449","pcpfaxno":2075644461,"pcpnpi":1598017048,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8AE3EE5RT76","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4891","I4820","H25813","H5000","R7303","M19071","I10","R600","M51370","M47817","M9903","M5450","M9902","M546","M549","D6869","I25119","Z0000","S6991XA","I4811","S9031XA","L0390","Z5181","R2242","M79662","K810","R5382","R10813","R110","R630","K828","K5730","M48061","M5126","M4317","Z0101","H16213","S99921A","S99929A","H532","H2513","Z7901","Z20822","M01X71","I517","I480","I129","E785","R7309"],"date":["2025-10-28","2025-11-11","2023-08-09","2023-08-09","2024-04-01","2025-03-04","2024-10-17","2025-03-18","2024-12-03","2025-01-31","2025-01-08","2025-01-31","2025-01-08","2025-01-08","2024-12-03","2024-05-23","2024-05-23","2025-04-11","2025-11-02","2024-10-17","2025-03-18","2025-03-18","2024-10-14","2025-03-18","2025-06-05","2023-05-04","2023-05-04","2023-04-18","2023-04-18","2023-04-18","2023-04-18","2023-04-18","2025-01-31","2025-01-31","2025-01-31","2023-01-18","2023-01-18","2025-03-04","2025-03-04","2023-06-05","2023-06-05","2023-04-18","2023-04-18","2025-03-18","2024-11-11","2022-10-12","2022-09-13","2022-09-13","2022-09-13"],"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":[["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","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":""}]}]}