{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Joyce E Libby","gend":1,"currentgend":"","add":"76 EMERALD RD","city":"Holden","state":"ME","zip":"04429","dob":"1948-04-20","age":"","mstatus":"","insh":"10000025659","cliId":"","pno":2079897198,"cno":"","email":"","ename":"","eno":"","pphy":"HATCH CLEIN, ANNETTE M","ppno":2079890550,"pcpadd":"43 WHITING HILL RD STE 300,","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121006","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"76 EMERALD RD","madd2":"","madd3":"","mcity":"Holden","mstate":"ME","mzip":"04429","pcpfaxno":2079890551,"pcpnpi":1336189109,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5YY4E26RW94","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I639","G8111","Z1231","R059","M5450","R338","M25511","M79601","M79604","M62838","M79651","R350","N390","H6122","E1140","H9311","H6123","Z7982","Z7902","I471","I69351","I2510","K219","M25561","N319","I10","R600","M1990","I69319","R112","E785","R079","M21371","M25371","M25671","E1159","Z79899","M7918","M5116","K5900","R1084","Z87440","R399","R140","Z960","Z8673","M5416","Z09","B3731","R300","E119","Z7401","B351","M79671","M79672","Z87891","R0981","Z03818","E1142","R051","M79674","L299","H9313","R110","N760","G8191","R0982","K6289","R32","R0600","J069","R531","I69398","R52","J0190","S31809A","R69","R739","R252","M4800","Z794","M7989","I214","R0602","Z23","I69391","R61","R9439","Z955","R062","Z743","M25571","Z0389","Z0100","Z20822","M6281","R1033","I2119","R0902","R109","Z0000","J9811","U071","R339","G8194","L84","M205X1","Z7901","Z5181","I7770","I69322","I6782","I6389"],"date":["2025-09-10","2025-09-18","2024-10-23","2024-05-31","2024-01-19","2023-07-27","2023-01-19","2024-06-14","2024-06-14","2024-12-18","2024-01-22","2025-07-27","2024-03-11","2023-10-09","2024-01-30","2025-02-04","2025-02-04","2025-02-04","2025-02-04","2022-12-21","2025-02-16","2025-08-19","2025-02-16","2024-02-15","2024-02-15","2025-08-19","2023-09-28","2025-02-16","2022-12-20","2023-06-05","2025-08-19","2025-08-19","2024-10-17","2024-10-17","2024-10-17","2024-09-11","2024-12-18","2024-06-13","2025-01-21","2025-07-27","2025-07-27","2025-05-19","2025-08-05","2023-06-05","2023-04-05","2023-04-05","2025-06-09","2025-05-19","2024-02-05","2024-07-19","2024-06-01","2025-05-25","2023-05-11","2023-05-11","2023-05-11","2025-05-19","2023-01-16","2023-01-16","2024-07-01","2024-02-05","2023-05-16","2024-07-15","2023-07-27","2023-02-16","2023-05-27","2024-03-07","2023-10-18","2025-07-27","2024-04-19","2024-05-31","2024-05-31","2024-01-22","2024-04-30","2024-01-21","2023-04-24","2022-10-27","2023-07-19","2023-07-19","2023-11-30","2023-11-30","2024-03-07","2023-05-11","2025-05-25","2024-05-31","2024-10-03","2023-11-01","2023-01-30","2025-07-22","2025-07-22","2023-10-18","2023-07-20","2023-05-16","2023-07-20","2025-02-27","2023-07-19","2023-05-30","2023-05-27","2023-05-30","2024-05-31","2023-05-27","2024-11-25","2025-05-25","2022-09-29","2022-09-19","2022-09-19","2022-09-22","2022-09-22","2022-07-28","2022-07-21","2022-06-25","2022-07-06","2022-06-22","2022-06-22"],"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":[["","","FREESTYLE LIBRE 2 PLUS SENSOR","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","FREESTYLE LIBRE 2 READER","","","Select","Select",""],["","","CEFTRIAXONE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","MIRABEGRON ER","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","SODIUM CHLORIDE","","","Select","Select",""],["","","INSULIN GLARGINE SOLOSTAR","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","ACETIC ACID","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","ULTRA-FINE MINI PEN NEEDLE","","","Select","Select",""],["","","INSULIN GLARGINE","","","Select","Select",""],["","","ULTRA-FINE PEN NEEDLE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY READER","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","LANTUS","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","RANOLAZINE ER","","","Select","Select",""],["","","VANCOMYCIN HCL","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","PREMARIN","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY SENSOR","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","FOSFOMYCIN TROMETHAMINE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","LIDOCAINE HCL","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","NOVOLOG","","","Select","Select",""],["","","HEPARIN SODIUM","","","Select","Select",""],["","","DILTIAZEM HCL","","","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":""}]}]}