{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David A Luce","gend":0,"currentgend":"","add":"20 MARCH CIR","city":"Bangor","state":"ME","zip":"04401","dob":"1940-11-25","age":"","mstatus":"","insh":"10000024154","cliId":"","pno":2074043405,"cno":"","email":"declined@06032025.org","ename":"","eno":"","pphy":"RONCO, PAUL G","ppno":2079476141,"pcpadd":"43 WHITING HILL RD,SUITE 300","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121005","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"20 MARCH CIR","madd2":"","madd3":"","mcity":"Bangor","mstate":"ME","mzip":"04401","pcpfaxno":2079476720,"pcpnpi":1033152582,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6Y13GT5JM79","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G459","H353211","H353221","C44629","N179","D649","I4510","I2510","R0602","E119","E785","E876","H26491","E1165","N289","R7989","Z0001","L570","D485","D225","L814","L821","Z7189","R471","R0989","E1140","E1159","C44519","R079","I6523","E1151","M7741","M7742","I130","N1830","I5030","R4789","I509","Z23","R5383","L820","L538","Z98890","Z09","R9439","S80262A","W57XXXA","Z7982","Z794","Z87891","D6869","M159","L929","I2720","I081","Z0101","R600","R002","K820","M7989","E113311","E113392","I779","H26492","N189","D631","Z944","M25572","Z0000","R42","R6889","K5900","R10814","K625","M160","M79662","M170","D692","H353132","H26493","H43813","Z961","M25561","R10819","Z8719","E669","I6503","I6522","E1122","G4762","Z95820","Z7901","R0609","I110","I361","I4892","I10","I480","I5032","K7689","K649","D122","D124","D509","Z1211","D127","K640","E611","R195","I4891","Z951","K921"],"date":["2024-10-04","2025-11-07","2025-11-07","2025-04-07","2024-09-26","2025-10-15","2024-09-25","2024-09-27","2024-08-09","2025-07-30","2024-09-26","2024-09-26","2025-01-29","2024-04-26","2024-09-25","2024-09-24","2025-06-30","2025-07-08","2025-01-08","2025-07-08","2025-07-08","2025-07-08","2025-01-08","2024-09-25","2024-08-21","2023-07-28","2023-07-28","2025-06-02","2024-09-24","2024-11-15","2025-06-26","2025-06-26","2025-06-26","2024-09-27","2025-10-01","2024-09-27","2024-09-25","2024-11-08","2024-10-04","2024-12-18","2025-03-31","2025-03-31","2025-06-27","2024-10-04","2024-12-19","2024-05-16","2024-05-16","2024-05-16","2024-05-16","2025-10-01","2024-09-27","2024-09-27","2025-04-07","2024-08-12","2024-08-12","2025-06-03","2025-10-16","2024-09-11","2024-07-25","2025-10-15","2023-03-06","2023-03-06","2025-06-24","2023-01-25","2023-03-02","2023-03-02","2022-12-08","2025-10-16","2023-06-20","2023-06-20","2023-06-07","2023-02-01","2023-02-01","2023-02-01","2023-06-02","2025-10-15","2023-06-02","2025-07-08","2022-11-28","2022-11-28","2022-11-28","2023-01-30","2025-07-14","2023-02-01","2023-02-01","2023-02-01","2025-06-24","2025-06-24","2025-06-03","2022-12-07","2022-11-07","2022-11-07","2022-11-23","2022-11-23","2022-11-23","2022-10-14","2022-10-07","2022-10-14","2022-10-14","2022-09-07","2022-09-07","2022-08-03","2022-08-03","2022-07-28","2022-08-03","2022-08-03","2022-08-03","2022-07-21","2022-07-14","2022-06-21","2022-06-21","2022-06-17"],"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":[["","","FLUAD 2025-2026","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}