{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Linda C Steeves","gend":1,"currentgend":"","add":"110 TAPLEY RD","city":"Buxton","state":"ME","zip":"04093","dob":"1946-03-10","age":"","mstatus":"","insh":"10000011932","cliId":"","pno":2079294590,"cno":"","email":"","ename":"","eno":"","pphy":"MCKENNEY, BRANDY M","ppno":2078399101,"pcpadd":"Mercy Gorham Crossing Primary Care,19 S Gorham Crossing","pcpcity":"Gorham","pcpstate":"ME","pcpzip":"04038","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE GORHAM","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"110 TAPLEY RD","madd2":"","madd3":"","mcity":"Buxton","mstate":"ME","mzip":"04093","pcpfaxno":2078399201,"pcpnpi":1659458511,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9MA1UN5RN19","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C3490","C3431","T45AX5D","L270","C3411","R911","Z5111","R112","E8352","T451X5A","L659","M47817","M47816","M438X6","M4310","D492","L570","L718","Z85828","M5416","C3491","I129","E1122","N1830","J439","E8342","Z79899","Z1231","R918","J449","J438","Z98890","J90","C3480","Z4682","J9811","I3489","M4726","M4727","M4807","M4185","M5116","R7309","R6889","Z01818","Z87891","K219","N179","N1832","Z0000","Z7689","Z0101","K5730","K2270","Z860100","M810","Z7983","N189","Z5112","J939","I700","I10","E119","D487","Z1211","Q742","K760","G8929","M5450","I2510","M160","M25551","M25552","R6520","J9601","Z794","G629","A419","N281","Z9049","R0902","Z452","R7989","R531","M25559","Z48813","L2989","T50905A","J929","D381","M1611","J811","J189","M799","A408","R748","M419","E1165","R0600","R079","R1011","N23","L710","L578"],"date":["2025-07-03","2025-11-12","2025-10-02","2025-09-03","2025-11-12","2025-10-10","2025-04-02","2025-05-21","2025-05-21","2025-05-21","2024-04-02","2025-10-13","2025-09-17","2025-04-21","2025-04-21","2023-10-17","2024-10-15","2024-10-15","2024-10-15","2025-08-26","2024-12-05","2025-08-20","2025-08-20","2025-08-20","2025-08-20","2025-11-12","2025-02-17","2025-09-11","2025-10-13","2024-12-05","2023-04-28","2024-12-13","2025-10-13","2024-10-10","2024-12-06","2025-10-13","2024-10-28","2025-06-05","2025-06-05","2025-06-05","2025-06-05","2025-06-05","2023-12-08","2023-06-05","2024-10-27","2025-10-15","2025-07-22","2025-07-16","2025-07-08","2024-08-16","2024-01-30","2025-07-29","2025-07-22","2025-07-22","2025-07-22","2023-11-13","2023-11-13","2023-04-12","2025-07-30","2024-09-17","2025-10-10","2025-10-15","2024-04-18","2024-10-10","2025-07-22","2023-04-18","2024-10-10","2025-04-21","2025-04-21","2025-10-10","2025-09-17","2025-10-13","2025-10-13","2025-10-15","2025-10-22","2024-08-13","2024-06-28","2025-11-03","2024-04-10","2024-04-10","2025-10-19","2025-10-19","2024-04-10","2025-10-10","2025-10-10","2024-08-20","2025-10-02","2025-10-02","2025-10-10","2024-08-20","2025-10-13","2025-10-13","2025-10-13","2025-10-13","2025-10-14","2025-11-05","2024-06-26","2025-09-18","2025-10-10","2022-11-03","2022-11-03","2022-10-21","2022-10-18","2022-10-18"],"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":[["","","GABAPENTIN","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLUOCINONIDE","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","ACCU-CHEK SOFTCLIX","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","FREESTYLE LITE METER","","","Select","Select",""],["","","ACCU-CHEK FASTCLIX LANCING DEV","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","UNIFINE PENTIPS PLUS","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","DICLOFENAC SODIUM ER","","","Select","Select",""],["","","FAMOTIDINE","","","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":""}]}]}