{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Arthur W Young","gend":0,"currentgend":"","add":"11 COWPATH WAY","city":"ELLSWORTH","state":"ME","zip":"04605","dob":"1947-05-04","age":"","mstatus":"","insh":"10000018832","cliId":"","pno":2076673027,"cno":"","email":"wineoisin@hotmail.com","ename":"","eno":"","pphy":"KOLISCH, ANITA D","ppno":2076647780,"pcpadd":"32 RESORT WAY,","pcpcity":"ELLSWORTH","pcpstate":"ME","pcpzip":"46051717","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"11 COWPATH WAY","madd2":"","madd3":"","mcity":"ELLSWORTH","mstate":"ME","mzip":"04605","pcpfaxno":2076647721,"pcpnpi":1447283981,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3KJ2NP8KK24","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K5732","S90829A","M25562","M1712","Z0000","E039","R109","E785","R251","M79674","G5761","S61412A","Q6671","Z7189","K921","M2041","M79671","Z4889","J45909","R1030","R0789","Z9049","H2513","K648","D509","Z8711","Z820","Z23","R195","R9082","R1032","L739","I739","E663","S90859A","N400","Z0101","H5203","H524","H52223","M75101","M19011","M19012","M25512"],"date":["2023-03-23","2024-08-22","2023-02-03","2025-07-24","2024-08-07","2025-08-12","2023-05-19","2024-08-22","2024-07-30","2023-12-06","2024-11-21","2024-02-07","2024-11-21","2025-08-12","2023-07-06","2025-05-07","2024-03-12","2024-04-09","2024-06-25","2023-02-24","2023-02-24","2023-02-24","2024-04-22","2023-07-06","2023-07-06","2023-07-06","2024-07-30","2024-02-07","2023-01-19","2024-08-27","2023-03-23","2024-07-10","2022-10-24","2022-10-24","2025-05-07","2022-11-10","2025-09-15","2025-09-15","2025-09-15","2025-09-15","2022-08-05","2022-08-05","2022-07-22","2022-07-22"],"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":[["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","PFIZER 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":""}]}]}