{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Grant R Lee","gend":0,"currentgend":"","add":"8 LEE WAY","city":"Ellsworth","state":"ME","zip":"04605","dob":"1947-01-30","age":"","mstatus":"","insh":"10000015823","cliId":"","pno":2078121320,"cno":2075731134,"email":"ULYSSES_04092@YAHOO.COM","ename":"","eno":"","pphy":"DEL MUNDO, WINFRED F","ppno":2076647770,"pcpadd":"Ellsworth Family Practice,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":"8 LEE WAY","madd2":"","madd3":"","mcity":"Ellsworth","mstate":"ME","mzip":"04605","pcpfaxno":2076647723,"pcpnpi":1417925116,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4U31M77RK39","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R0789","R002","I10","I2510","R0989","N182","R809","Z760","M12812","I214","Z955","I129","R9431","J0190","Z0000","M75112","M67814","M19012","M25512","E785","I6521","R079","E1165","R7303","I429","R000","L03115","N269","L570","J310","H608X3","S058X9A","C61","E782","I2584","I513","E8809","N390","E119","Z8546","K219","I951","I255","R001","N189","E1122","E559","Z122","Z9989","U071","R6883","J029","Z79899","N041","I701","H11123","L989","Z7902","Z7982","R0600","I499","J3489","M7582","N529"],"date":["2025-02-09","2025-02-09","2025-04-04","2025-06-04","2023-05-05","2025-04-04","2025-04-04","2023-09-08","2024-11-13","2023-04-21","2024-05-30","2025-04-03","2023-11-20","2024-04-19","2025-06-25","2024-11-25","2024-11-25","2024-11-25","2025-08-11","2025-03-25","2023-05-05","2025-02-09","2022-11-26","2025-06-24","2025-02-10","2025-02-10","2024-06-12","2025-04-04","2024-11-04","2025-09-18","2022-10-20","2023-11-06","2023-05-08","2022-12-02","2022-12-02","2022-12-02","2024-05-31","2024-05-31","2024-08-01","2024-07-25","2022-11-30","2022-11-30","2025-03-25","2024-10-03","2022-12-07","2022-12-07","2023-05-23","2024-07-10","2022-11-30","2023-09-08","2023-09-08","2023-09-08","2023-05-22","2023-12-13","2023-12-13","2023-11-06","2025-09-18","2022-12-23","2022-12-23","2023-05-31","2023-05-08","2024-05-30","2024-07-12","2022-06-15"],"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":[["","","FARXIGA","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","SIMVASTATIN","","","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":""}]}]}