{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Judith Stitham","gend":1,"currentgend":"","add":"208 CAMP BENSON RD","city":"NEWPORT","state":"ME","zip":"04953","dob":"1947-06-28","age":"","mstatus":"","insh":"10000018156","cliId":"","pno":2073412051,"cno":"","email":"jstitham@gmail.com","ename":"","eno":"","pphy":"DAY, BETHANY N","ppno":2073685747,"pcpadd":"Northern Light Health Center Newport Plaza,26 Main St Ste 2","pcpcity":"Newport","pcpstate":"ME","pcpzip":"04953","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HEALTH CENTER NEWPORT PLAZA","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"208 CAMP BENSON RD","madd2":"","madd3":"","mcity":"NEWPORT","mstate":"ME","mzip":"04953","pcpfaxno":2073685483,"pcpnpi":1023361953,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7WU2KC7UY13","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1211","Z0100","Z0000","G4700","F411","H26493","R110","F32A","Z1231","R450","F419","K449","D649","R1013","U071","M9903","M5136","M5386","M9904","R5383","Z48815","R198","E860","R300","R6889","H1013","H16223","F330","R790","R002","J4540","R0602","D509","R0600","R42","Z96652","Z13820","M8580"],"date":["2025-08-26","2025-08-20","2025-04-24","2025-06-17","2025-11-06","2024-08-19","2025-07-01","2025-06-23","2025-05-19","2025-07-01","2025-08-06","2023-11-27","2023-06-22","2023-11-04","2023-05-12","2023-10-10","2023-10-10","2023-10-10","2023-10-10","2023-12-11","2023-12-11","2023-10-17","2023-12-01","2023-05-25","2023-08-16","2023-11-13","2023-11-13","2024-01-18","2024-04-11","2022-10-17","2022-10-12","2022-09-11","2022-09-21","2022-09-11","2022-09-02","2022-07-05","2022-07-01","2022-07-01"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","ARNUITY ELLIPTA","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","METOCLOPRAMIDE HCL","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","PAROXETINE HCL","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ADVAIR DISKUS","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","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":""}]}]}