{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John Rivers","gend":0,"currentgend":"","add":"33 PARKER RIDGE LN COTTAGE 53","city":"BLUE HILL","state":"ME","zip":"04614","dob":"1950-07-18","age":"","mstatus":"","insh":"10000013546","cliId":"","pno":2073747088,"cno":"","email":"bluehillbirders@gmail.com","ename":"","eno":"","pphy":"LESKO, LISA A","ppno":2073742311,"pcpadd":"Blue Hill Family Medicine,57 Water St","pcpcity":"Blue Hill","pcpstate":"ME","pcpzip":"04614","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BLUE HILL","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"33 PARKER RIDGE LN COTTAGE 53","madd2":"","madd3":"","mcity":"BLUE HILL","mstate":"ME","mzip":"04614","pcpfaxno":2073742618,"pcpnpi":1720022866,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7W32D39MH18","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H40013","H04123","H35373","H35342","Z0000","M25561","S72001A","Z48815","Z471","Z96641","K562","E871","I10","G20C","R1032","L820","D0439","I350","S63257A","W1839XA","D485","I119","Q439","G903","S72011A","R55","G20A1","S79912A","S8991XA","Z961","R6889","Z136","S72011D","R000","R140","D3132","H35372","H35371","H33301","G20","Z7982","W1840XA","R1310","R1084","I2699","N3281","H527","H4912","L578","L821","D1801","L570","Z96651","C44329","Z96652","K5909","R531","Z96653","H532","Z7689","S72091A","M1611","D649","S72009A","H1131","Q438","M79605","J309","S6992XA","K6389","K5989","N3941","M7989","S0592XA","S72001D","L03116","M1812","I2720","I77810","N2889","H33311","I951","Z79899","R32","R011","Z1211","R918","G20A2","K625","R296","N3289","R300","G4700","I441","R5383","M25562"],"date":["2025-01-16","2025-01-16","2025-07-22","2025-01-16","2024-08-30","2025-07-03","2024-03-15","2024-08-28","2025-01-15","2025-05-21","2024-07-29","2024-07-24","2024-07-24","2024-07-24","2024-07-18","2025-05-13","2025-06-24","2025-01-23","2025-03-28","2025-03-28","2025-05-13","2025-06-16","2024-12-17","2024-08-01","2023-12-05","2024-02-13","2025-09-03","2023-12-05","2023-12-05","2022-11-03","2023-04-18","2025-08-22","2024-02-21","2023-12-07","2024-07-19","2023-08-16","2023-08-16","2023-08-16","2023-08-16","2023-08-18","2022-10-14","2023-12-04","2024-10-08","2023-12-14","2023-12-14","2023-07-26","2025-04-15","2025-04-15","2024-11-11","2024-11-11","2023-11-07","2023-11-07","2025-01-15","2024-12-06","2025-01-15","2024-02-14","2025-01-15","2025-01-15","2024-02-28","2024-01-22","2023-12-06","2023-12-06","2024-04-02","2023-12-05","2023-10-11","2023-06-28","2025-05-03","2025-03-11","2025-04-04","2024-07-19","2024-07-18","2023-05-05","2025-04-04","2023-09-20","2023-12-21","2023-04-04","2025-03-28","2023-12-11","2024-12-04","2023-12-07","2023-05-03","2025-02-28","2025-02-28","2024-07-10","2023-05-05","2025-01-28","2023-12-10","2024-08-23","2023-06-08","2024-01-04","2023-02-21","2023-10-26","2024-08-23","2023-12-22","2025-02-28","2025-06-17"],"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":[["","","LINZESS","","","Select","Select",""],["","","RASAGILINE MESYLATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","MIDODRINE HCL","","","Select","Select",""],["","","CARBIDOPA-LEVODOPA ER","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","Select","Select",""],["","","METHYLPHENIDATE HCL ER (CD)","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","METOCLOPRAMIDE HCL","","","Select","Select",""],["","","METHYLPHENIDATE ER (LA)","","","Select","Select",""],["","","FLUDROCORTISONE ACETATE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","XIIDRA","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","CARBIDOPA-LEVODOPA","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","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":""}]}]}