{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kelsey Stone","gend":0,"currentgend":"","add":"202 CORINTH RD","city":"HUDSON","state":"ME","zip":"04449","dob":"1936-07-12","age":"","mstatus":"","insh":"10000011457","cliId":"","pno":2073270003,"cno":"","email":"","ename":"","eno":"","pphy":"JURGENS, PAUL J","ppno":2079412373,"pcpadd":"Northern Light 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":2073270003,"add2":"","add3":"","madd1":"202 CORINTH RD","madd2":"","madd3":"","mcity":"HUDSON","mstate":"ME","mzip":"04449","pcpfaxno":2079418803,"pcpnpi":1629590484,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9HX0NP0VD09","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","E119","I10","I4891","I509","N390","D225","L821","L814","Z08","H401111","H2512","H353131","H40032","I77819","I2720","D485","H401134","H259","J984","H401131","E871","I77810","Z79899","R300","R319","N401","R351","H26491","D229","Z7189","Z794","Z7984","I872","K5900","Z87891","I6523","I5030","E785","I4821","I5032","I110","Z0001","B9620","N400","R0602","S80862A","R399","S20421A","X58XXXA","Z7901","R338","Z87440","H6123","L570","H3530","N179","H02133","I5033","I288","E1136","Z7982","M1A9XX0","H2513","I160","E1151","E11620","E6601","H353132"],"date":["2025-05-19","2025-05-19","2025-05-19","2025-05-19","2025-02-03","2025-08-06","2025-08-27","2025-08-27","2025-08-27","2024-08-27","2023-05-08","2024-03-18","2024-07-22","2023-05-08","2023-06-22","2023-06-22","2023-11-29","2025-11-03","2025-11-03","2024-12-01","2024-03-18","2024-04-01","2024-04-01","2025-10-21","2023-12-19","2023-12-19","2025-10-21","2023-12-19","2023-01-10","2023-06-02","2023-06-02","2025-11-03","2024-09-11","2025-08-27","2025-06-28","2025-10-15","2023-05-24","2025-04-03","2025-04-03","2024-09-16","2024-09-16","2025-04-03","2024-05-01","2025-08-06","2025-08-06","2024-04-23","2023-07-18","2024-01-09","2025-10-15","2025-10-15","2024-09-11","2025-10-21","2025-10-21","2023-11-27","2024-08-27","2025-11-03","2025-06-27","2023-09-05","2024-12-02","2024-04-24","2023-11-07","2023-10-30","2023-11-07","2024-07-22","2024-04-23","2022-10-15","2022-10-15","2022-10-15","2022-09-06"],"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":[["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","DOXAZOSIN MESYLATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","LEVEMIR FLEXTOUCH","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","INSULIN GLARGINE-YFGN","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","LEVEMIR FLEXPEN","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","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":""}]}]}