{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rosemary Holleman","gend":1,"currentgend":"","add":"24 SEBAGO LAKE RD","city":"GORHAM","state":"ME","zip":"04038","dob":"1946-05-15","age":"","mstatus":"","insh":"10000012274","cliId":"","pno":2078922177,"cno":"","email":"declined@08072025.com","ename":"","eno":"","pphy":"LANE, MEGAN E","ppno":2075351340,"pcpadd":"66 LEIGHTON RD,","pcpcity":"FALMOUTH","pcpstate":"ME","pcpzip":"41052225","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE WEST FALMOUTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2076536362,"add2":"","add3":"","madd1":"24 SEBAGO LAKE RD","madd2":"","madd3":"","mcity":"GORHAM","mstate":"ME","mzip":"04038","pcpfaxno":2078788797,"pcpnpi":1831103647,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5AW2RA1ME10","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R490","F4310","I308","N3000","R300","H401131","I10","M25562","M79631","J301","L821","L570","H7202","Z961","R519","S0990XA","M542","S199XXA","J040","H6123","S0101XA","H47233","R197","Z4802","H43813","D492","J0190","J069","S0191XD","M8588","Z9109","M85852","D225","D1801","D485","R498","E039","E785","K589","F411","Z0000","Z8589","Z85828","L578","Z1231","R195","R030","Z7982","N390","L820","Z23","L718","J309","D509","L720","J029","J310","Z20822","R051","R058","K449","K2980","K317","K635","Z86010","K5730","K5900","Z862","D123","K219"],"date":["2025-10-23","2025-11-05","2025-03-25","2025-05-20","2025-05-20","2025-07-22","2025-07-01","2025-05-27","2025-05-27","2023-05-17","2025-09-30","2025-09-30","2024-02-28","2022-12-27","2025-09-09","2025-09-09","2025-09-09","2025-09-09","2022-12-21","2024-02-28","2025-09-09","2025-07-22","2025-02-21","2025-09-17","2025-03-20","2025-03-25","2025-04-06","2025-04-03","2025-10-17","2025-06-20","2023-02-15","2025-06-20","2025-09-30","2025-09-30","2025-09-30","2024-06-27","2024-01-05","2022-12-09","2025-07-01","2025-07-01","2022-12-14","2022-12-14","2023-09-28","2023-09-28","2025-08-01","2025-03-05","2025-03-05","2025-03-05","2025-05-07","2023-09-28","2022-11-09","2022-11-15","2022-09-28","2022-09-28","2022-09-27","2022-08-29","2022-08-12","2022-08-08","2022-08-08","2022-08-29","2022-07-27","2022-07-27","2022-07-27","2022-07-27","2022-07-27","2022-07-27","2022-07-22","2022-07-22","2022-07-27","2022-07-27"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","FELODIPINE ER","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","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":""}]}]}