{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ralph L Michaud","gend":0,"currentgend":"","add":"281 Center Dr","city":"Orrington","state":"ME","zip":"04474","dob":"1945-12-20","age":"","mstatus":"","insh":"10000012377","cliId":"","pno":2078251035,"cno":"","email":"frenchie04474@yahoo.com","ename":"","eno":"","pphy":"Paul J Jurgens","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":2078251035,"add2":"","add3":"","madd1":"281 Center Dr","madd2":"","madd3":"","mcity":"Orrington","mstate":"ME","mzip":"04474","pcpfaxno":2079418803,"pcpnpi":1629590484,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2AU2HM8EE87","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D120","Z8521","H9201","H61009","Z923","C781","J432","C3431","G4734","Z0000","R058","D122","D124","D125","J449","I7140","M25552","C321","C3490","R935","K219","F17210","Z08","J439","J90","Z902","Z87891","J328","H61001","J988","J441","Z9981","C3411","C771","R0602","Z85118","Z23","C329","I10","C3491","E039","E785","M150","Z720","Z9002","N400","M542","H6691","H9211","Z01818"],"date":["2025-04-09","2023-10-16","2023-09-21","2023-09-21","2023-09-21","2022-10-06","2024-11-13","2024-11-13","2024-11-13","2024-08-02","2025-06-04","2025-04-09","2025-04-09","2025-04-09","2025-07-27","2025-04-30","2025-03-31","2022-11-25","2023-03-29","2022-12-08","2022-12-08","2025-06-04","2025-05-28","2022-10-04","2022-10-04","2022-10-06","2022-12-19","2023-10-16","2023-10-16","2025-06-04","2025-06-04","2025-06-04","2022-12-19","2022-12-19","2025-06-03","2025-06-03","2022-10-10","2024-08-06","2024-09-06","2024-09-06","2024-03-14","2023-07-27","2024-09-06","2023-03-29","2022-11-29","2022-12-30","2022-12-30","2022-07-18","2022-07-18","2022-07-15"],"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":[["","","BREZTRI AEROSPHERE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HYDROCORT","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","SPIRIVA RESPIMAT","","","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":""}]}]}