{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia M Ouellette","gend":1,"currentgend":"","add":"138 POWERS RD","city":"PITTSFIELD","state":"ME","zip":"04967","dob":"1946-09-16","age":"","mstatus":"","insh":"10000026851","cliId":"","pno":2074872835,"cno":2074168828,"email":"patour885@gmail.com","ename":"","eno":"","pphy":"Badeen, Steven J","ppno":2073684292,"pcpadd":"100 MAIN ST,","pcpcity":"NEWPORT","pcpstate":"ME","pcpzip":"04953","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE NEWPORT","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 625","madd2":"","madd3":"","mcity":"PITTSFIELD","mstate":"ME","mzip":"04967","pcpfaxno":"","pcpnpi":1801984471,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1DK4QC9EQ09","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","M9905","M5450","M7918","G250","R079","M9903","M5136","M9904","R7989","M5416","Z01818","G629","E6601","J189","R0609","Z20822","M25551","B029","Z1231","E538","S83282A","N390","G4733","Z9989","R399","L600","Z4889","M1712","L538","R600","J449","R0602","R062","N816","M23612","M23352","M23332","Z1211","Z466","E669","J029","Z20818","Z0001","J069","Z01812","Z0100","L03032","R21","S70362A","W57XXXA","M9902","R059"],"date":["2024-12-13","2023-12-27","2023-01-17","2023-01-17","2022-07-22","2024-06-11","2023-12-27","2023-12-27","2023-12-27","2024-04-09","2023-01-20","2025-06-17","2024-07-15","2024-06-27","2022-11-14","2022-11-14","2022-11-14","2024-09-24","2025-03-11","2024-08-08","2024-05-16","2024-10-02","2025-01-04","2025-06-01","2024-12-31","2024-11-27","2022-10-03","2022-11-08","2025-06-17","2022-11-08","2022-11-08","2022-11-14","2022-11-14","2022-11-14","2023-10-26","2024-10-02","2024-10-02","2024-10-02","2024-08-13","2024-08-21","2025-05-12","2023-03-19","2023-03-19","2024-12-12","2022-11-12","2025-04-09","2024-10-01","2022-08-22","2022-07-06","2022-07-06","2022-07-06","2022-06-29","2022-06-20"],"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":[["","","GABAPENTIN","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","POLYMYXIN B SUL-TRIMETHOPRIM","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","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":""}]}]}