{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mary Robinson","gend":1,"currentgend":"","add":"37 BRANCH MILLS RD","city":"PALERMO","state":"ME","zip":"04354","dob":"1947-04-23","age":"","mstatus":"","insh":"10000017270","cliId":"","pno":2079932442,"cno":"","email":"","ename":"","eno":"","pphy":"KRIEGEL, CHARLES B","ppno":"","pcpadd":"Sebasticook Valley Health,80 Main St","pcpcity":"Unity","pcpstate":"ME","pcpzip":"04988","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HEALTH CENTER UNITY","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 34","madd2":"","madd3":"","mcity":"PALERMO","mstate":"ME","mzip":"04354","pcpfaxno":2078613281,"pcpnpi":1497800734,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2PA2D79XK17","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R4189","R600","S99911A","S72112D","M1612","M47816","M4316","K8020","M898X9","Z0000","M170","J929","S72002D","D649","S72112A","S7292XA","S8002XA","L03116","M7989","Z7982","M25562","W19XXXA","S0990XA","E860","I959","N390","X58XXXD","S72115D","M19071","S40022A","R0789","I10","J439","J984","Z23","R590","M79604","M1712","M7632","R221","M25571","M79622","W1830XD","R634","Z0101","J029","F419","S72002A","Z8781","B351","L851","M2042","M2041","Z0001","M79652","Z0389","M19012","R079","J449","I951","M4186","M419","S76112A","M4185","R911","R809","L03115","M7031","D510","S59902A","M11261","R0609"],"date":["2024-03-07","2025-03-07","2025-03-25","2025-01-03","2023-09-05","2023-08-11","2023-08-11","2025-10-17","2023-08-11","2025-08-26","2025-10-30","2024-05-07","2025-03-06","2025-05-21","2025-02-28","2024-12-12","2024-12-12","2024-03-13","2025-08-01","2025-01-03","2025-07-29","2024-12-12","2024-12-12","2024-05-07","2024-05-07","2024-05-07","2025-01-03","2025-04-07","2025-03-18","2025-03-07","2023-03-06","2023-03-13","2024-02-15","2024-02-15","2023-01-04","2024-11-27","2025-06-24","2025-08-07","2023-10-24","2024-11-27","2025-06-23","2025-02-28","2025-02-28","2025-03-03","2023-02-24","2024-10-31","2024-01-17","2025-01-05","2025-04-07","2025-01-03","2025-01-03","2025-01-03","2025-01-03","2024-01-30","2024-12-12","2024-12-18","2024-12-18","2023-03-06","2023-04-03","2024-05-07","2023-09-05","2023-08-17","2023-10-24","2023-10-24","2024-02-15","2025-05-29","2025-07-14","2025-06-30","2024-01-31","2024-12-12","2025-10-13","2022-11-21"],"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":[["","","OMEPRAZOLE","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PERPHENAZINE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","PREVIDENT 5000 DRY MOUTH","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(EUA)","","","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":""}]}]}