{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Debbie M Morgan","gend":1,"currentgend":"","add":"727 HUDSON HILL RD","city":"HUDSON","state":"ME","zip":"04449","dob":"1961-09-23","age":"","mstatus":"","insh":"10000011485","cliId":"","pno":2072170601,"cno":"","email":"phyrehart@tds.net","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":"727 HUDSON HILL RD","madd2":"","madd3":"","mcity":"HUDSON","mstate":"ME","mzip":"04449","pcpfaxno":2079890551,"pcpnpi":1497313696,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2XH1MJ1XR18","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H5203","H524","R102","Z79891","K529","H25013","H5710","M25562","M25561","Z0000","N3941","Z0001","N952","R1031","E2839","R7303","K5730","R140","R197","E6601","Z6843","M25512","M19012","H5713","R569","F331","E785","Z1231","R109","Z124","Z79899","R32","G2581","Z23","G8929","R051","H538","H43393","R0602","J029","Z20822","Z87891","Z6841","N838","Z713","Z7182"],"date":["2025-03-24","2025-03-24","2025-01-20","2024-04-12","2025-06-19","2025-03-24","2024-02-07","2024-01-05","2024-01-05","2023-09-06","2025-04-16","2025-03-11","2024-11-25","2025-06-19","2024-11-25","2024-12-27","2025-01-06","2025-01-20","2025-01-20","2023-07-12","2023-07-12","2023-07-12","2023-07-12","2023-09-06","2023-09-06","2024-02-07","2023-09-06","2025-04-22","2025-01-06","2024-11-25","2024-04-12","2025-04-16","2025-02-12","2023-11-02","2025-06-19","2023-12-12","2024-06-18","2024-06-27","2023-12-12","2023-12-12","2023-12-12","2024-02-07","2023-01-10","2024-10-29","2022-09-02","2022-09-02"],"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":[["","","TRAZODONE HCL","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","ROPINIROLE HCL","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","LOPERAMIDE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","PRAMIPEXOLE DIHYDROCHLORIDE","","","Select","Select",""],["","","COLESTIPOL HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","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":""}]}]}