{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"William M Shufelt","gend":0,"currentgend":"","add":"84 CRAFT RD","city":"Greenville","state":"ME","zip":"04441","dob":"1942-09-28","age":"","mstatus":"","insh":"10000027095","cliId":"","pno":2076953613,"cno":"","email":"","ename":"","eno":"","pphy":"ROOPE, SHELLY L","ppno":2078764811,"pcpadd":"22 HALEY CT,","pcpcity":"SANGERVILLE","pcpstate":"ME","pcpzip":"44793000","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE SANGERVILLE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 78","madd2":"","madd3":"","mcity":"Greenville","mstate":"ME","mzip":"04441","pcpfaxno":2078764302,"pcpnpi":1487021259,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2J35Y11XN62","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F1090","T8452XA","A4101","R6521","G9341","I776","M310","Z5181","T8450XD","Z952","I050","Z5189","B9561","S72002D","Z7901","Z0000","I3481","R1310","R52","S46012A","M25552","L0231","R6330","T8141XA","N179","I422","M25559","M19012","K5989","N281","N289","K439","J9811","J9809","J90","J984","Z743","Z471","Z96641","C679","T8149XD","T8149XA","L089","R443","T8452XD","R531","M96840","E8342","S72001A","N401","T8141XD","Z96642","S79911A","F03B4","K521","F419","L7632","S72001D","R350","Z98890","K5730","J069","Y792","Z792","G9389","I10","Z0001","Z09","R059","R29818","S72011A","R4182","R519","W19XXXD","E039","K4020","K5790","I6782","S72002A","F05","W000XXA","T1490XA","W19XXXA","Z87891","N3281","Z23","D696"],"date":["2025-04-02","2025-05-22","2023-04-03","2023-04-12","2023-04-03","2023-04-17","2023-05-01","2025-09-04","2023-04-19","2024-09-20","2024-09-20","2023-05-30","2025-05-22","2023-03-20","2024-02-15","2024-08-12","2024-09-20","2025-04-03","2023-03-23","2023-03-31","2023-03-26","2023-03-23","2023-03-28","2023-03-23","2023-03-23","2023-04-24","2023-03-24","2023-03-26","2023-04-10","2024-12-29","2023-04-10","2023-04-10","2023-04-10","2023-04-10","2023-04-10","2023-04-10","2023-04-03","2024-12-19","2024-12-19","2024-04-22","2023-05-08","2023-04-28","2023-05-10","2025-04-21","2023-05-30","2023-05-30","2025-02-26","2025-07-23","2025-04-02","2025-04-17","2023-04-24","2023-07-05","2024-12-17","2023-04-24","2023-04-24","2025-07-29","2024-12-29","2025-02-12","2024-01-19","2024-12-29","2024-12-29","2023-01-17","2025-05-22","2025-05-22","2025-05-14","2024-12-10","2025-08-25","2025-02-12","2023-01-17","2023-01-18","2024-12-17","2025-04-03","2025-05-14","2023-03-06","2023-03-06","2023-03-23","2023-03-23","2023-03-24","2023-03-20","2023-02-27","2023-02-27","2023-02-23","2023-02-24","2023-02-24","2023-10-19","2022-09-24","2022-08-01"],"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":[["","","TOLTERODINE TARTRATE ER","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","LOSARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","MINOCYCLINE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(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":""}]}]}