{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"James H French","gend":0,"currentgend":"","add":"12 FRENCH CONNECTION","city":"GUILFORD","state":"ME","zip":"04443","dob":"1946-07-11","age":"","mstatus":"","insh":"10000013090","cliId":"","pno":2078769008,"cno":"","email":"","ename":"","eno":"","pphy":"ROOPE, SHELLY L","ppno":2078764811,"pcpadd":"22 HALEY CT,","pcpcity":"SANGERVILLE","pcpstate":"ME","pcpzip":"44793000","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE SANGERVILLE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 163","madd2":"","madd3":"","mcity":"GUILFORD","mstate":"ME","mzip":"04443","pcpfaxno":2078764302,"pcpnpi":1487021259,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5CE2DK0MD84","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5136","K8051","N281","J189","Z0001","J8410","E1151","E1165","M21372","J1282","B351","K7030","M9903","M4317","M9904","M5417","R0609","U071","R29898","Z0000","H5213","H524","H52203","K7460","Z01818","J479","E6601","R053","J849","Z9049","Z8719","M5137","R5383","N401","M170","M5418","E1142","L089","Z0101","G609","M19041","Z98890","I371","M48061","M5117","M5116","M4727","M25562","R338","K7689","I70203","Z4802","J984","M5416","R059","J90","M2042","M25561","I77810","Z5181","K760","E119","I70209"],"date":["2024-09-04","2023-03-31","2023-03-31","2024-01-04","2025-04-14","2025-07-22","2025-07-25","2025-07-16","2024-11-14","2024-02-07","2025-05-08","2025-05-13","2024-02-28","2024-02-28","2024-02-28","2024-07-09","2025-03-03","2024-01-24","2024-01-25","2023-03-14","2025-03-25","2025-03-25","2025-03-25","2025-06-10","2024-04-16","2025-07-29","2024-04-10","2025-02-03","2025-07-29","2024-12-06","2024-12-06","2024-04-09","2023-03-27","2025-01-17","2023-11-22","2024-04-19","2024-04-19","2024-05-07","2024-10-03","2024-10-03","2024-06-03","2024-05-28","2024-05-11","2024-05-14","2024-05-14","2024-05-14","2024-05-14","2023-12-04","2023-01-10","2024-05-01","2022-12-16","2024-06-03","2024-02-07","2024-08-23","2024-03-05","2024-01-04","2024-05-07","2023-11-22","2024-05-11","2025-06-05","2024-05-01","2022-09-01","2022-07-11"],"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":[["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-200","","","Select","Select",""],["","","URSODIOL","","","Select","Select",""],["","","LOVASTATIN","","","Select","Select",""],["","","ATROVENT HFA","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LEVEMIR FLEXPEN","","","Select","Select",""],["","","ULTRA-FINE SHORT PEN NEEDLE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","INSULIN DEGLUDEC PEN (U-100)","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","TRUEPLUS PEN NEEDLE","","","Select","Select",""],["","","DEXCOM G7 RECEIVER","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","PIRFENIDONE","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","LEVEMIR FLEXTOUCH","","","Select","Select",""],["","","UNIFINE PENTIPS","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","OFEV","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","ULTRA-FINE PEN NEEDLE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ESBRIET","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-100","","","Select","Select",""],["","","METFORMIN HCL","","","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":""}]}]}