{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Peter A Hansen","gend":0,"currentgend":"","add":"140 MAPLE ST","city":"Bangor","state":"ME","zip":"04401","dob":"1943-10-10","age":"","mstatus":"","insh":"10000015367","cliId":"","pno":2079453349,"cno":"","email":"","ename":"","eno":"","pphy":"GREBLIUNAITE, RUTA","ppno":2079412373,"pcpadd":"EMMC 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":"","add2":"","add3":"","madd1":"140 MAPLE ST","madd2":"","madd3":"","mcity":"Bangor","mstate":"ME","mzip":"04401","pcpfaxno":2079418803,"pcpnpi":1922487412,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6JH6CK6RD77","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D225","L821","L814","L280","L570","Z08","Z85828","D485","C61","Z0000","M65332","R519","R42","R4781","R29810","R202","I4891","I639","R1031","I129","N1830","Z8546","Z923","Z7901","G5601","D2271","I4710","I4720","I491","Z0001","L738","Z0101","H353131","H40013","H43813","H5213","I10","C4402","Z125","G8929","M549","M542","C44319","G5603","I63512","K529","Z9079","R6889","I480","G6289","R7301","R809","I6782","H538","Z09","Z8673","Z7982","K627","D1801","L308"],"date":["2025-02-27","2025-02-27","2025-02-27","2025-02-27","2025-08-28","2024-02-27","2024-02-27","2024-08-27","2025-02-28","2024-11-13","2023-01-18","2024-08-05","2022-12-27","2025-05-09","2025-05-09","2024-02-13","2025-07-15","2025-05-30","2023-06-19","2024-02-08","2024-11-29","2024-02-14","2025-02-28","2025-08-25","2025-05-06","2024-08-27","2025-06-30","2025-06-30","2025-06-30","2024-12-26","2024-02-27","2025-09-04","2025-09-04","2025-09-04","2025-09-04","2025-09-04","2025-05-30","2024-07-23","2024-08-09","2024-05-01","2024-05-01","2024-05-01","2022-10-26","2025-02-25","2025-05-10","2023-01-24","2023-01-24","2023-04-11","2025-08-04","2025-02-10","2023-04-27","2023-05-30","2024-02-08","2024-02-08","2025-08-25","2025-08-25","2025-08-25","2022-12-27","2022-08-18","2022-08-18"],"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":[["","","OMEPRAZOLE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","METOCLOPRAMIDE HCL","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","CARBAMAZEPINE ER","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","SHINGRIX","","","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":""}]}]}