{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Beverly R Knight","gend":1,"currentgend":"","add":"176 SCHOOL ST APT 2A","city":"UNITY","state":"ME","zip":"04988","dob":"1948-05-10","age":"","mstatus":"","insh":"10000025658","cliId":"","pno":2076494233,"cno":"","email":"wbedknight@gmail.com","ename":"","eno":"","pphy":"KRIEGEL, CHARLES B","ppno":"","pcpadd":"Sebasticook Valley Health,80 Main St","pcpcity":"Unity","pcpstate":"ME","pcpzip":"04988","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HEALTH CENTER UNITY","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"176 SCHOOL ST APT 2A","madd2":"","madd3":"","mcity":"UNITY","mstate":"ME","mzip":"04988","pcpfaxno":2078613281,"pcpnpi":1497800734,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9RP0YH1QU25","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M810","R928","K8020","R197","H8101","R059","I519","I340","M7712","R0789","K8000","M9901","M9902","M5033","M5134","D3131","Z0000","H8110","H8111","R278","M62838","M542","L989","Z0001","H18513","Z961","H5051","H52223","H35363","Z0101","H40033","J449","N6325","R0602","R2681","N6324","I10","L723","H90A22","S0990XA","W1839XA","Z79899","R1013","Z743","R079","N390","R1084","S199XXA","H903","J440","H8109","M549","H90A31","I509","R0609","H538","M546","M4724","R9431","E785","J439","R42","G319","N6489","R922","E041","C73","I7300","R112","R0902","J432","H3540","H35372"],"date":["2023-08-21","2025-01-08","2025-07-02","2025-06-02","2025-10-16","2023-11-16","2024-11-01","2024-11-01","2023-11-16","2023-11-16","2025-05-13","2023-06-19","2023-06-19","2023-06-19","2023-06-19","2025-07-24","2024-10-07","2024-03-12","2024-04-17","2024-04-17","2024-04-17","2024-04-17","2023-10-27","2025-10-08","2023-11-06","2023-05-12","2023-11-06","2023-05-12","2023-11-06","2023-11-06","2023-11-06","2025-04-07","2025-01-08","2024-10-09","2023-09-05","2025-01-08","2025-01-07","2024-06-27","2024-12-17","2023-03-18","2023-03-18","2023-01-04","2025-05-05","2025-05-05","2025-11-07","2025-05-05","2025-05-05","2023-03-13","2023-06-16","2024-05-30","2023-11-30","2022-11-29","2023-08-09","2024-10-09","2024-10-09","2022-11-07","2022-10-25","2022-10-28","2022-10-12","2022-10-12","2022-10-12","2022-08-09","2022-08-11","2022-08-08","2022-08-08","2022-08-03","2022-08-03","2022-08-01","2022-07-30","2022-07-30","2022-06-28","2022-06-23","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",""],["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","METHIMAZOLE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","TRIAMTERENE-HYDROCHLOROTHIAZID","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUARIX QUAD 2023-2024","","","Select","Select",""],["","","AFLURIA TRIV 2024-25 (3YR UP)","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","DICLOFENAC POTASSIUM","","","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":""}]}]}