{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Reginald T Murray","gend":0,"currentgend":"","add":"29 MURRAY RD","city":"NORTH VASSALBORO","state":"ME","zip":"04962","dob":"1944-04-19","age":"","mstatus":"","insh":"10000021736","cliId":"","pno":2079237001,"cno":"","email":"","ename":"","eno":"","pphy":"SHEARER, WARREN A","ppno":2079455247,"pcpadd":"PO BOX 1599,PENOBSCOT COMMUNITY HEALTH CENTER","pcpcity":"BANGOR","pcpstate":"ME","pcpzip":"44021599","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE CLINTON","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 174","madd2":"","madd3":"","mcity":"NORTH VASSALBORO","mstate":"ME","mzip":"04962","pcpfaxno":2079922065,"pcpnpi":1205037439,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3PP8E94FT54","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H401130","Z23","Z0000","H25813","H43813","R4189","G319","F0390","E559","H02883","H02886","H04123","H2513","E041","E1122","N182","R413","Z0001","H01111","H01114","H01112","H01115","G309","E119","E785","M79645","R7303"],"date":["2024-06-25","2023-11-15","2023-08-28","2024-05-23","2024-05-23","2025-09-23","2025-04-08","2025-03-26","2025-04-16","2025-01-13","2025-01-13","2025-01-13","2023-05-16","2024-08-21","2023-08-28","2023-08-28","2025-05-14","2024-08-14","2025-05-20","2025-05-20","2025-05-20","2025-05-20","2025-04-16","2023-02-27","2023-02-27","2022-08-23","2022-08-23"],"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":[["","","TIMOLOL MALEATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","BRIMONIDINE TARTRATE","","","Select","Select",""],["","","DORZOLAMIDE HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","NYSTATIN-TRIAMCINOLONE","","","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":""}]}]}