{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Chester R Kane","gend":0,"currentgend":"","add":"489 NORTH BEND RD","city":"Surry","state":"ME","zip":"04684","dob":"1944-10-18","age":"","mstatus":"","insh":"10000015885","cliId":"","pno":2076677832,"cno":"","email":"declined@07262023.com","ename":"","eno":"","pphy":"CROWLEY, KERRY W","ppno":2079634066,"pcpadd":"50 UNION ST,ELEANOR WIDENER DIXON MEMORIAL CLINIC","pcpcity":"ELLSWORTH","pcpstate":"ME","pcpzip":"46051586","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE GOULDSBORO","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"489 NORTH BEND RD","madd2":"","madd3":"","mcity":"Surry","mstate":"ME","mzip":"04684","pcpfaxno":2079637723,"pcpnpi":1679511075,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5R22PX7GJ08","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L729","E119","L03116","R310","M25552","M25562","Z0000","E039","L570","I10","E785","R7301","I2510","N1832","M109","L989","Z85828","Z0101","Z7189","M1712","M7989","Z7982","R319","M5432","E1122","N1830","M51369","N189","M51379","M4807","M5127","M51360","M47817","R300"],"date":["2023-12-21","2025-06-24","2023-04-15","2024-06-20","2025-01-23","2023-04-15","2025-06-10","2025-03-11","2023-12-11","2025-03-11","2023-06-14","2023-06-14","2025-03-11","2024-09-25","2025-03-11","2023-12-11","2023-12-11","2023-10-20","2025-06-10","2023-04-15","2023-04-15","2024-02-29","2024-06-20","2024-11-23","2024-12-20","2024-12-20","2024-11-29","2024-06-20","2025-01-16","2025-01-16","2025-01-16","2025-01-16","2025-01-16","2024-06-20"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","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":""}]}]}