{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Suzanne Shores","gend":1,"currentgend":"","add":"49 E BENTON RD","city":"Benton","state":"ME","zip":"04901","dob":"1948-07-02","age":"","mstatus":"","insh":"10000026622","cliId":"","pno":2078775348,"cno":2078775348,"email":"Happyagain70248@aol.com","ename":"","eno":"","pphy":"GASPER, JONATHAN L","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":"49 E BENTON RD","madd2":"","madd3":"","mcity":"Benton","mstate":"ME","mzip":"04901","pcpfaxno":2076243845,"pcpnpi":1932133592,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2XW3T74RJ73","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L570","C44629","C44722","L409","Z1283","C44729","L97229","Z0000","L03116","L97529","R600","Z08","Z85828","C44521","C44529","E669","L97829","Z0100","Z1231","M869","S43402A","S7002XA","L820","S0990XA","S79912A","Z79899","Z86007","Z872","I87333","I87339","I83028","Z89422","T8781","R6889","Y835","I87312","L97929","L309","Z98890","D485","D045","L97819","I87332","L97526","L97828","L905","N1830","I129","L03032","G629","S40012A","R1031","R1011","R110","D0461","Z0001","C44329","S92912A","T8131XA","C4492","L4050","M5450","I10","C44622","M5136","M47816","M25552","Z4781","B353","L988","H5213","H524","H52223","L989","D0472","C44709","Y838","L720","I83893","I878","I739","Z87891","L98491","M898X7","N281","R609","Z09","Z5189"],"date":["2025-10-16","2024-10-16","2024-10-16","2025-04-24","2024-01-29","2025-09-08","2023-01-30","2024-07-10","2023-02-13","2023-02-24","2023-10-24","2023-01-30","2024-11-14","2023-02-02","2024-09-19","2023-09-21","2023-07-24","2025-10-30","2022-12-21","2023-02-24","2023-05-12","2023-05-12","2025-04-24","2023-05-12","2023-05-12","2025-09-09","2024-11-14","2024-11-14","2023-07-24","2023-07-13","2023-02-27","2023-04-04","2023-04-25","2023-01-19","2023-04-04","2023-04-04","2023-04-27","2022-12-19","2023-01-03","2024-11-14","2024-11-14","2023-07-24","2023-03-27","2023-02-13","2023-02-13","2025-08-26","2025-07-23","2025-07-23","2023-02-21","2023-04-10","2023-05-12","2023-05-12","2023-05-12","2023-05-12","2024-11-14","2025-11-05","2024-08-20","2023-02-24","2023-04-27","2023-12-06","2024-09-16","2024-09-16","2024-09-16","2025-08-26","2024-07-15","2024-07-15","2024-07-15","2023-03-06","2025-10-16","2023-01-03","2024-10-24","2024-10-24","2024-10-24","2023-10-12","2023-01-05","2023-10-27","2023-04-25","2025-04-24","2023-08-15","2023-08-15","2023-08-15","2025-07-23","2023-02-24","2023-02-24","2024-07-25","2022-10-20","2022-08-12","2022-08-29"],"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":[["","","KETOCONAZOLE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","TREMFYA ONE-PRESS","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}