{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ruth I Jacobsen","gend":1,"currentgend":"","add":"1 BESSEY SCHOOL DR APT 218","city":"Scarborough","state":"ME","zip":"04074","dob":"1938-09-13","age":"","mstatus":"","insh":"10000018466","cliId":"","pno":"","cno":2072896535,"email":"Ruthjac104@yahoo.com","ename":"","eno":"","pphy":"MCKENNEY, BRANDY M","ppno":2078399101,"pcpadd":"Mercy Gorham Crossing Primary Care,19 S Gorham Crossing","pcpcity":"Gorham","pcpstate":"ME","pcpzip":"04038","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE GORHAM","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1 BESSEY SCHOOL DR APT 218","madd2":"","madd3":"","mcity":"Scarborough","mstate":"ME","mzip":"04074","pcpfaxno":2078399201,"pcpnpi":1659458511,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9WA1DD1YK07","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R600","J9621","J449","R4182","G9340","Z743","J9612","J9622","F03A0","M6281","I10","J9602","I499","E1142","E559","E039","E785","R062","E119","H16223","H40023","R269","J129","Z09","W19XXXA","D649","E538","J439","R627","Z9981","S92354A","R413","M8008XA","G928","Z66","J9611","S4991XA","S8992XA","S199XXA","I82409","R262","K047","R8279","T148XXA","R531","R2243","S0003XA","S299XXA","A000","E1165","S92351A","S92351D","R0902","S0990XA","S6992XA","H353221","H353111","R0989","M546","Z87891","Z8669","H35373","E1140","S4981XA","S80911A","C44729","Z741","F32A","R2681","M1990","R296","S79911A","S3992XA","R110","K5730","D259","K8020","M8008XD","R4189","Z0001","D492","R5381","F0390","Z0101","S32010A","Z789","M797","S99921A","S32019A","H18593","M8000XA","D225","L814","L821","L568","D509","R32","S92334D","S92344D","R102","G9341","R509","J432","M79604","L910","L299","M25571","I7389","B351","M79674","T17300A","S99912A","R791","M25572","E8729","J441","R61","R7989","I080","I422","N858","R1031","I82412","L02416","M47812","S99922A","M19072","M85872","J984","S32000A","X501XXA","J8489","Z0000","M7072","M349","F349","J9610"],"date":["2025-08-20","2025-08-20","2025-08-15","2025-05-22","2025-05-22","2025-05-22","2025-07-01","2025-05-13","2025-08-20","2025-08-20","2025-07-30","2025-05-13","2025-07-24","2024-05-29","2022-12-13","2023-10-09","2022-12-13","2025-06-03","2025-07-29","2025-07-29","2025-07-29","2025-07-03","2025-06-14","2023-11-14","2025-05-12","2024-02-14","2023-08-01","2023-10-13","2023-10-11","2023-07-05","2024-03-05","2024-04-26","2023-05-31","2023-10-06","2023-05-27","2023-10-20","2023-07-05","2023-07-05","2025-05-12","2023-10-20","2023-10-20","2023-10-20","2025-04-29","2023-06-13","2023-10-04","2023-10-04","2024-08-10","2024-08-10","2023-10-22","2023-10-15","2024-04-16","2024-05-28","2025-04-29","2025-05-12","2024-08-10","2025-05-07","2025-05-07","2023-07-05","2024-08-10","2024-08-10","2024-12-30","2024-12-30","2025-04-08","2023-07-05","2023-07-05","2024-02-05","2023-07-25","2023-07-25","2023-07-25","2023-07-25","2025-05-19","2023-05-31","2023-05-26","2023-05-26","2023-06-01","2023-06-01","2023-06-01","2023-07-04","2023-10-03","2024-10-16","2024-01-26","2023-07-07","2023-07-07","2024-09-25","2023-06-07","2023-06-02","2023-06-02","2024-03-03","2023-05-26","2024-09-25","2023-06-02","2025-01-17","2025-01-17","2025-01-17","2025-01-17","2023-10-03","2023-10-03","2024-05-28","2024-05-28","2023-07-03","2025-05-19","2023-10-05","2023-10-05","2023-10-04","2025-01-17","2025-01-17","2023-09-25","2023-09-25","2023-09-25","2023-09-25","2025-05-15","2023-04-21","2023-10-08","2025-05-12","2025-05-12","2025-05-19","2023-10-05","2023-10-05","2023-10-05","2023-10-05","2023-07-03","2023-07-03","2023-10-12","2024-01-11","2023-10-04","2023-04-21","2023-04-21","2023-04-21","2023-10-07","2023-05-31","2023-04-21","2022-08-25","2022-06-30","2022-06-30","2022-06-30","2022-07-06","2022-07-06"],"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":[["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","DORZOLAMIDE-TIMOLOL","","","Select","Select",""],["","","SYNTHROID","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","ARIPIPRAZOLE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","RIVASTIGMINE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","MORPHINE SULFATE","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","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":""}]}]}