{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Peter Sly","gend":0,"currentgend":"","add":"88 HILLSIDE RD","city":"Brooklin","state":"ME","zip":"04616","dob":"1946-09-11","age":"","mstatus":"","insh":"10000013480","cliId":"","pno":2074602321,"cno":"","email":"peter_sly@msn.com","ename":"","eno":"","pphy":"RENSENBRINK, KATHRYN","ppno":2076647780,"pcpadd":"Northern Light Primary Care Ellsworth,32 Resort Way","pcpcity":"Ellsworth","pcpstate":"ME","pcpzip":"04605","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"88 HILLSIDE RD","madd2":"","madd3":"","mcity":"Brooklin","mstate":"ME","mzip":"04616","pcpfaxno":2076647721,"pcpnpi":1124067194,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4T37K54ND44","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H26493","H04123","F3181","Z7189","G319","H905","H903","I10","I739","G3184","M25512","S82292D","S82302D","U071","Z96653","S82202A","Z471","Z4789","Z0000","R4586","R9082","L570","L821","L814","D225","I8393","I77810","Z125","R6889","S82202D","S82402D","X58XXXD","V134XXD","S069XAS","M25461","I2510","E7800","M79662","S61411A","W268XXA","Z79899","L720","L853","L600","S76311A","H8110","S82209A","S61419A","R29898","L738","M79651"],"date":["2025-01-22","2025-01-22","2025-07-09","2023-01-25","2024-03-14","2024-03-14","2025-07-17","2023-12-05","2025-08-21","2025-08-21","2025-05-23","2022-11-08","2022-11-08","2025-08-29","2022-11-23","2023-09-05","2022-11-23","2023-09-05","2025-03-17","2024-01-11","2024-01-11","2024-09-18","2024-09-18","2024-09-18","2024-09-18","2023-09-06","2024-12-17","2022-11-10","2023-01-01","2024-05-29","2024-05-29","2024-05-29","2024-05-29","2024-12-04","2023-12-05","2023-12-05","2023-12-05","2024-05-29","2024-09-03","2024-09-03","2024-04-23","2024-09-18","2023-05-18","2023-05-18","2023-01-06","2023-05-18","2023-02-28","2022-08-29","2022-09-08","2022-08-29","2022-06-22"],"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":[["","","KETOCONAZOLE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","TEMAZEPAM","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","AMMONIUM LACTATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","ARIPIPRAZOLE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","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":""}]}]}