{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Edwin F Butler","gend":0,"currentgend":"","add":"16 BUTLER RD","city":"Mount Desert","state":"ME","zip":"04660","dob":"1943-04-30","age":"","mstatus":"","insh":"10000016309","cliId":"","pno":2072765559,"cno":2072663424,"email":"efbutlerjr@yahoo.com","ename":"","eno":"","pphy":"BAXTER, CLARKE W","ppno":2072445513,"pcpadd":"4760 RED BANK RD STE 104,","pcpcity":"CINCINNATI","pcpstate":"OH","pcpzip":"45227154","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2072443397,"add2":"","add3":"","madd1":"PO BOX 13","madd2":"","madd3":"","mcity":"Southwest Harbor","mstate":"ME","mzip":"04679","pcpfaxno":2072445515,"pcpnpi":1487711909,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5E38UC4MU56","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C4371","Z5111","C438","Z471","I350","I2510","I083","I700","I10","H0011","Z01818","C439","E559","Z006","N3041","L270","R5383","M7122","M25462","Z96652","J320","J029","J358","I444","Z08","M1712","H02841","M7910","Z85820","Z98890","C61","Z23","T8189XA","Z952","J4489","H26492","H04563","Z96653","H0014","H0015","R0600","R7989","M5450","R42","Z96651","A6920","D3132","H26493","H43393","M1711","L570","D225","L814","L821","L2089","N3040","N393","N529","Z79899","J3489","D62","C7989","Z7189","L818","I708","K551","M79604","D485","Z0000","K627","E7800","M170","L03116","Z882","Z880","L728","Z01810","R0602","J45909","Z789","R208","L538","J4541","H26491","C792","I7120","R053","T148XXA","Z09","R109","Z4802","R600","M79661","S81001A","M6281","R059","L918","Z01812","Z8249","D1801","L218","R011","R399","Z0189","R0781","M25762","M25761","M79672","S99922A","Z139"],"date":["2023-11-29","2023-10-30","2023-06-12","2025-07-14","2023-07-13","2025-03-21","2023-03-17","2023-03-17","2025-03-21","2025-03-14","2025-03-05","2025-06-23","2025-07-25","2023-05-03","2023-05-08","2024-02-12","2025-07-25","2022-11-11","2022-11-11","2025-01-28","2025-08-21","2023-10-26","2023-10-26","2024-12-04","2025-05-07","2024-12-04","2025-02-04","2023-06-27","2025-05-07","2025-05-07","2025-07-17","2025-05-01","2023-09-11","2025-03-21","2025-03-21","2025-03-06","2025-03-06","2025-07-14","2025-07-03","2025-07-03","2024-02-27","2025-07-17","2023-09-28","2023-09-28","2025-08-12","2024-07-25","2024-10-22","2024-10-22","2024-10-22","2025-04-02","2024-11-04","2025-03-05","2025-03-05","2025-03-05","2024-11-04","2023-12-05","2023-12-05","2023-12-05","2023-04-18","2025-08-21","2023-05-08","2023-06-07","2023-12-01","2023-06-14","2023-04-03","2023-04-03","2025-04-10","2024-06-04","2025-05-01","2022-12-08","2023-09-25","2025-03-03","2024-07-22","2024-07-22","2024-07-22","2024-06-04","2024-06-10","2023-05-02","2024-01-02","2024-06-04","2024-06-04","2024-06-04","2024-02-27","2024-10-22","2023-05-25","2024-01-02","2023-06-26","2023-08-30","2023-06-04","2024-04-15","2023-07-24","2025-04-10","2025-04-10","2023-09-13","2024-02-01","2023-12-26","2025-03-05","2025-08-20","2023-02-22","2023-05-25","2023-05-25","2022-12-10","2024-11-12","2024-11-25","2023-07-17","2022-08-25","2022-08-25","2022-08-08","2022-08-08","2022-06-14"],"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":[["","","ALLOPURINOL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","NITROFURANTOIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","ADVAIR HFA","","","Select","Select",""],["","","ABRYSVO","","","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":""}]}]}