{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Earle J Peters","gend":0,"currentgend":"","add":"51 MARGINAL WAY","city":"NEWPORT","state":"ME","zip":"04953","dob":"1947-06-14","age":"","mstatus":"","insh":"10000018564","cliId":"","pno":2077450428,"cno":"","email":"earlejpeters@gmail.com","ename":"","eno":"","pphy":"ARCEO, REYNALDO A","ppno":2074875154,"pcpadd":"470 SOMERSET AVE,","pcpcity":"PITTSFIELD","pcpstate":"ME","pcpzip":"49674928","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE PITTSFIELD","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"51 MARGINAL WAY","madd2":"","madd3":"","mcity":"NEWPORT","mstate":"ME","mzip":"04953","pcpfaxno":2074873158,"pcpnpi":1144347196,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4XD4PU3HU76","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R6889","C9000","D472","M542","C9002","B370","Z8579","Z0001","I4891","J029","S72001A","M25551","Z0000","U071","M9901","M50322","M9902","M62830","M25562","Z7961","Z87891","Z801","M1611","C9001","S01511A","S025XXA","W228XXA","M5412","S72001D","R29898","M4802","M7918","M064","I499","G629","R531","M2550","D759","M4856XA","Z09","R591","R590","M4722","M5010","M4723","R200","M359"],"date":["2023-04-22","2025-10-01","2025-05-05","2025-10-01","2025-05-05","2025-06-14","2023-08-08","2025-07-22","2025-10-07","2025-08-01","2025-04-09","2025-06-04","2024-07-16","2023-02-02","2025-05-02","2025-05-02","2025-05-02","2025-05-02","2025-05-30","2025-10-01","2025-10-01","2025-10-01","2025-05-23","2024-01-11","2024-11-25","2024-11-25","2024-11-25","2022-12-21","2025-05-30","2022-10-13","2022-10-13","2022-10-13","2022-08-26","2022-08-08","2022-07-11","2022-07-11","2022-07-11","2022-07-01","2022-07-01","2022-06-24","2022-06-24","2022-06-23","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2022-06-15"],"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":[["","","ACYCLOVIR","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","ATOVAQUONE","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","LENALIDOMIDE","","","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":""}]}]}