{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Doris E Bicknell","gend":1,"currentgend":"","add":"286 FALMOUTH RD","city":"Windham","state":"ME","zip":"04062","dob":"1946-12-07","age":"","mstatus":"","insh":"10000015487","cliId":"","pno":2075729453,"cno":"","email":"DECLINE@2024.COM","ename":"","eno":"","pphy":"LAVALLEE, HEATHER A","ppno":2078930290,"pcpadd":"100 FODEN ROAD,WEST BUILDING SUITE 103","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41062351","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"286 FALMOUTH RD","madd2":"","madd3":"","mcity":"Windham","mstate":"ME","mzip":"04062","pcpfaxno":2078280188,"pcpnpi":1841569720,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1XK4G08WN77","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R0602","R262","M6281","M2550","E119","R531","M25611","R4189","R2232","J9601","Z006","E6601","I350","K219","E785","R4182","T82857A","Z954","L988","B351","E1149","R062","I081","E1165","R918","E875","L851","J069","E1151","L989","E1122","L02512","B029","E8770","I083","Z952","L600","L03114","E782","R0609","A419","L98491","L98499","H348111","E113392","H43813","H35033","Z6841","I10","I3481","I342","Z0101","E1159","I129","N1832","T8092XA","M67432","M1812","K449","M19071","E1142","L539","N3000","J189","E1169","S4991XA","Z48812","M25511","N179","R188","J984","T82857D","S0101XA","S199XXA","S0990XA","H348110","U071","R300","Z953","R931","I422","D3612","M79632","N904","I119","I5033","W19XXXA","K8020","I517","M8589","D6869","I130","M19041","S90822A","Y831","Z01818","Z043","S8991XA","S3991XA","S3993XA","S299XXA","A4159","E113211","M25571","R059","Z1231","E041","R0600","I2510","Z09","H1132","Z98890","D509","Z01810","K029","I708","Z7901","Z5320","G8929","I700","M7989","K056","M25651","R7989","R2681","Z794","R413","E11649","L729","N189","N7689"],"date":["2024-05-16","2024-02-21","2023-06-16","2023-06-16","2025-07-01","2024-02-21","2024-02-21","2025-08-11","2025-09-08","2024-06-24","2024-08-23","2024-09-26","2025-10-09","2024-08-22","2024-08-22","2024-08-22","2024-08-22","2024-04-01","2024-08-23","2025-09-25","2025-09-25","2024-05-13","2024-09-24","2024-09-30","2024-11-18","2024-04-16","2025-09-25","2024-05-11","2025-01-01","2024-06-28","2025-10-27","2024-07-09","2024-03-26","2024-03-22","2024-08-22","2024-08-23","2025-09-25","2024-07-30","2025-01-13","2024-03-17","2023-05-30","2024-08-06","2024-08-14","2025-11-13","2025-11-13","2024-04-29","2024-04-29","2024-09-26","2024-09-26","2025-10-06","2023-10-20","2025-04-08","2024-10-03","2025-01-13","2025-01-13","2024-08-22","2025-09-08","2025-09-08","2024-03-17","2025-06-23","2025-06-23","2025-08-22","2023-06-15","2023-06-15","2023-06-15","2024-08-20","2024-08-22","2023-05-26","2023-05-26","2023-05-26","2023-05-26","2024-10-22","2024-08-21","2024-08-20","2024-08-20","2023-05-22","2023-06-05","2023-06-05","2024-09-24","2024-09-24","2024-09-24","2025-10-02","2025-07-02","2023-12-04","2024-12-20","2023-05-30","2024-08-20","2024-11-18","2024-11-18","2023-11-22","2024-09-23","2024-09-23","2024-09-23","2025-09-28","2024-08-22","2024-08-19","2023-05-24","2024-08-20","2024-08-20","2024-08-20","2024-08-20","2023-06-19","2025-04-08","2025-05-19","2024-05-16","2023-08-16","2024-07-22","2024-06-26","2024-06-03","2023-06-28","2025-03-26","2024-06-24","2024-06-02","2024-06-26","2024-06-26","2024-06-10","2024-05-13","2024-05-13","2025-05-06","2024-05-13","2024-05-20","2024-06-10","2022-11-09","2022-11-14","2022-11-14","2022-11-14","2022-10-17","2022-08-12","2022-07-12","2022-07-12","2022-06-21"],"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":[["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","VASCEPA","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","NOVOLIN N","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","NOVOLOG","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","IRBESARTAN","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","INSULIN LISPRO","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","SPIRONOLACTONE-HCTZ","","","Select","Select",""],["","","VEO INSULIN SYRINGE","","","Select","Select",""],["","","ACCU-CHEK GUIDE TEST STRIP","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}