{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marie J Hruby Frake","gend":1,"currentgend":"","add":"5 ROB RD","city":"Brooklin","state":"ME","zip":"04616","dob":"1946-02-07","age":"","mstatus":"","insh":"10000012639","cliId":"","pno":2073598981,"cno":"","email":"MAHRFR@GMAIL.COM","ename":"","eno":"","pphy":"HOWE, KARYN","ppno":2076647780,"pcpadd":"Ellsworth Internal Medicine,32 Resort Way","pcpcity":"Ellsworth","pcpstate":"ME","pcpzip":"04605","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BLUE HILL","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2072666959,"add2":"","add3":"","madd1":"PO BOX 388","madd2":"","madd3":"","mcity":"Brooklin","mstate":"ME","mzip":"04616","pcpfaxno":2076647721,"pcpnpi":1104447820,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9AM9HK6KR21","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","L03116","M76822","Z792","R053","D1802","E785","R0609","M1239","R918","R319","R399","R0602","I4710","I2720","N281","K8689","Z79899","Z7722","Z23","N289","M25572","M19072","I6523","K439","K5730","M65872","R000","R911","R5383","R768","Z1211","Z1231","M25472","R350","D320","H26491","H35373","H04123","R300","J9811","J8410","J479","M542","M810","R32","R6889","M205X2","M2012","M79672","J40","R1310","R6330","D485","D225","L821","L814","Z09","M1230","R946","D329","N3941","N390","Z86011","G43B0","Z961","Z872","R3915","M069","M8580","M67874","M2550","L570"],"date":["2025-01-03","2023-12-01","2024-03-05","2023-12-01","2025-01-08","2024-03-25","2025-06-09","2025-01-14","2025-05-20","2024-10-21","2022-11-30","2022-11-14","2025-01-14","2025-01-14","2025-01-13","2022-12-22","2022-12-21","2022-12-14","2025-01-08","2024-11-05","2022-12-21","2024-03-13","2023-11-09","2025-02-21","2022-11-30","2022-11-30","2023-11-10","2025-03-07","2024-06-10","2024-09-09","2023-08-08","2024-10-11","2025-01-27","2023-11-09","2023-07-26","2025-06-14","2024-03-25","2024-03-25","2024-03-25","2024-12-21","2023-01-31","2023-01-31","2024-05-15","2025-02-21","2024-05-29","2023-03-20","2023-11-02","2023-12-27","2023-12-27","2023-12-27","2024-12-10","2024-08-14","2024-08-14","2023-02-22","2024-09-05","2025-06-16","2024-09-05","2025-06-16","2022-10-24","2022-10-17","2025-06-14","2023-07-28","2024-01-24","2024-06-05","2023-03-09","2023-03-09","2025-06-16","2024-04-30","2024-09-29","2024-09-29","2023-12-06","2022-09-20","2022-08-22"],"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":[["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","FLUOROURACIL","","","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":""}]}]}