{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia P Smith","gend":1,"currentgend":"","add":"24 TEE LN","city":"HANCOCK","state":"ME","zip":"04640","dob":"1938-02-15","age":"","mstatus":"","insh":"10000022363","cliId":"","pno":2074120108,"cno":"","email":"patty.smith6789@gmail.com","ename":"","eno":"","pphy":"BAXTER, CLARKE W","ppno":2072445513,"pcpadd":"4760 RED BANK RD STE 104,","pcpcity":"CINCINNATI","pcpstate":"OH","pcpzip":"45227154","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"24 TEE LN","madd2":"","madd3":"","mcity":"HANCOCK","mstate":"ME","mzip":"04640","pcpfaxno":2072445515,"pcpnpi":1487711909,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4WU7UX5TX62","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R0609","R9431","I5020","Z0000","R1032","K5790","N390","Z87440","R55","T8484XA","Z96641","S72001S","W19XXXS","K5730","E876","H9113","H903","R0602","C50911","R399","K5732","N3281","Z471","M1811","M25532","H5319","I5030","N393","R300","R6520","N179","K5792","M170","S32599A","L03031","G4710","S32591A","W19XXXA","Y9301","Y92000","I480","I10","E039","H04123","M25551","C50311","Z139","I509","M1711","S32599D","T8484XD","R197","R110","R1084","M6530","M65342","M19042","G4733","R0683","G4736","Z45018","S329XXA","Z09","D649","M48061","J439","R079","K634","R0600","Z98890","Z5181","K635","I824Z9","M25561","R5381","H35371","L538","H53121","H43813","J449","I6621","I252","R9389","M25562","M609","G9389","M25461","M79632","R413","M79602","R319","R0789","H6123","N289","Z510","S32591D","X58XXXD","L600","Z7901","Z79899","R109","M152","M79641","E785","Z950","E890","R001","S83241A","X58XXXA","B9620","K581","K648","I4891","K6389","Z1211","N83202","Z792","Z01810","Z95818","Z23","L659","M23221","M23261","Z886","A419","Z01812","S0012XA","R0902","Z01818","K5900","R29898","R918","G4700","D509","L03114","N281","K8020","S0990XA","S199XXA","I441","H6122","Z170","N644","M79645","M654","N6314","Z853","K9041","N6315","E8352","Z7189","I340","I2510","M23321","S83231A","R3129","M79604","Z885","R350","R3915","M810","M79651","Z8673","Z7982","S72009D","M80051D","Z13820","I82433","Z4789","M80051A","J9601","J181","J90","J9811","S72001A","S72051A","K219","R531","W010XXA","R1110","R401","S79911A","Z7401","S72041A"],"date":["2025-05-20","2023-09-30","2025-01-16","2025-07-25","2023-10-04","2023-10-04","2025-01-03","2025-04-07","2023-05-26","2024-03-26","2025-05-05","2023-07-07","2023-07-07","2023-10-03","2023-11-14","2023-06-08","2023-06-08","2025-04-24","2025-06-27","2024-12-09","2023-09-28","2025-04-07","2025-03-27","2025-01-14","2025-03-12","2024-09-20","2025-04-24","2025-04-07","2024-12-23","2023-05-26","2024-08-13","2023-10-10","2025-03-27","2025-06-25","2025-06-03","2023-06-07","2025-06-25","2025-05-15","2025-05-15","2025-05-15","2025-07-08","2024-11-03","2025-03-24","2024-09-20","2023-10-20","2024-09-12","2025-01-03","2025-01-10","2023-01-23","2025-05-15","2024-05-05","2023-05-24","2023-05-24","2023-10-03","2023-05-31","2023-05-31","2023-03-29","2023-07-19","2023-06-07","2023-06-07","2025-08-01","2025-06-24","2023-05-31","2025-06-24","2023-07-19","2024-08-04","2025-09-01","2023-09-29","2025-01-08","2023-03-22","2025-01-02","2023-10-17","2025-03-24","2025-03-27","2025-08-26","2023-07-05","2023-07-05","2023-07-05","2023-07-05","2025-01-28","2023-01-09","2023-01-09","2023-01-09","2025-03-27","2023-08-31","2023-05-24","2022-11-03","2025-02-06","2025-06-24","2025-02-06","2023-03-10","2025-04-14","2023-08-21","2024-08-22","2024-02-01","2025-06-25","2025-06-25","2025-06-03","2023-09-28","2024-05-21","2023-09-26","2025-01-14","2025-01-14","2023-04-25","2024-11-20","2025-05-05","2024-03-27","2023-01-18","2023-01-18","2023-03-16","2023-09-28","2023-09-28","2023-09-28","2023-09-27","2023-09-29","2023-10-03","2025-04-07","2023-09-19","2024-11-20","2024-10-03","2024-04-22","2023-01-23","2023-01-23","2023-01-23","2023-05-24","2024-02-28","2023-05-01","2025-08-07","2023-09-13","2023-09-13","2022-11-17","2025-04-24","2023-07-19","2023-07-19","2023-04-27","2023-09-27","2023-09-27","2025-05-02","2025-05-02","2024-03-30","2024-09-12","2024-01-31","2024-11-27","2024-02-02","2024-02-02","2023-11-16","2024-11-27","2024-01-16","2023-11-02","2023-11-28","2025-07-25","2024-11-03","2024-12-11","2022-11-29","2022-12-01","2022-09-22","2022-09-06","2022-09-06","2022-08-27","2022-08-27","2022-08-17","2022-08-29","2022-08-22","2022-08-22","2022-08-02","2022-06-30","2022-08-02","2022-06-28","2022-06-30","2022-06-28","2022-06-28","2022-06-28","2022-06-28","2022-06-25","2022-06-26","2022-06-24","2022-06-24","2022-06-23","2022-06-23","2022-06-24","2022-06-24","2022-06-23","2022-06-24","2022-06-23"],"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":[["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","ADVAIR HFA","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","BUMETANIDE","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","NITROFURANTOIN","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","SACUBITRIL-VALSARTAN","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","TRIAMTERENE-HYDROCHLOROTHIAZID","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","ABRYSVO","","","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":""}]}]}