{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"William S Leith","gend":0,"currentgend":"","add":"497 REACH RD","city":"Sedgwick","state":"ME","zip":"04676","dob":"1945-12-05","age":"","mstatus":"","insh":"10000024705","cliId":"","pno":2073595083,"cno":2076695002,"email":"cwleith@hotmail.com","ename":"","eno":"","pphy":"HOWE, KARYN","ppno":2076647780,"pcpadd":"Ellsworth Internal Medicine,32 Resort Way","pcpcity":"Ellsworth","pcpstate":"ME","pcpzip":"04605","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BLUE HILL","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"497 REACH RD","madd2":"","madd3":"","mcity":"Sedgwick","mstate":"ME","mzip":"04676","pcpfaxno":2076647721,"pcpnpi":1104447820,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8DW4Y08CD88","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R519","R509","R112","L570","L821","D1801","L814","Z7189","I10","Z23","D044","R0602","R059","H04123","H02403","H5032","M1812","D649","Z0000","M160","R6889","Z1211","E785","D485","L918","R208","R58","L538","R0600","L309","J020","H1013","K5730","N400","N281","E876","J449","M79642","J069","D2239","L089","D122","R195","A6920","L819","B078","M19042"],"date":["2025-07-06","2025-07-06","2025-07-06","2022-10-27","2025-07-16","2025-07-16","2025-07-16","2025-07-16","2025-06-09","2023-11-21","2023-10-31","2025-02-26","2025-02-26","2024-11-20","2024-11-20","2024-11-20","2023-09-15","2022-12-29","2025-01-17","2024-07-26","2023-11-17","2025-02-28","2025-01-13","2023-10-31","2023-10-31","2023-10-31","2023-10-31","2025-07-16","2022-12-07","2023-03-03","2024-04-29","2024-04-05","2025-07-06","2025-07-06","2025-07-06","2025-08-04","2025-08-05","2023-09-15","2025-01-22","2025-07-16","2025-07-16","2025-02-28","2025-02-28","2025-07-08","2025-07-16","2025-07-16","2022-08-25"],"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":[["","","CHLORTHALIDONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","SOD SULF-POTASS SULF-MAG SULF","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","MOMETASONE FUROATE","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO 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":[]}},{"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":""}]}]}