{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia A Lavaway","gend":1,"currentgend":"","add":"269 ST JAMES ST","city":"Westbrook","state":"ME","zip":"04092","dob":"1946-01-11","age":"","mstatus":"","insh":"10000027744","cliId":"","pno":2078542871,"cno":"","email":"declined@051023.com","ename":"","eno":"","pphy":"HORNE, JENNIFER L","ppno":2079737979,"pcpadd":"43 WHITING HILL RD,SUITE 300","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121005","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE GORHAM","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"665 SACO ST 269","madd2":"","madd3":"","mcity":"Westbrook","mstate":"ME","mzip":"04092","pcpfaxno":2079479579,"pcpnpi":1174903694,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7UN4A52NW06","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I872","L89893","I798","S91302A","I771","L98499","I480","T82898A","I739","H353114","H353211","H353134","L89899","I7091","B351","M79674","M79675","L851","M79671","M79672","A000","L97522","Z4781","K8020","R932","D259","K5909","K5720","I70245","Z7901","L03116","R262","K5792","E782","I4891","G8918","K5900","Z89512","R197","I129","Z20822","R051","F339","R933","F32A","Z5982","T148XXA","T82858A","L97529","M19072","N1830","I10","D649","L600","L89892","I70402","L7622","Z48812","Z0000","I70392","I70248","I70235","E785","K529","T8130XD","M7989","T8789","R2242","F17290","F17210","M85852","K5732","F17200","R4182","I2510","R2243","Z1231","I788","R609","R109","R918","R0609","R45851","I6523","T82392A","F331","Z7982","Z79899","Z9049","J3489","R202","Z89519","Z95828","I7389","Z23","H43811","H26493","H43393","I080","I499","Z950","R2233","H538","H4923","Z09","I70645","Z469","I70211","I70302","N1831","F40298","R600","S81002A","N858","H3530","M85851","Z1239"],"date":["2024-11-12","2024-02-29","2024-02-29","2024-09-10","2024-10-31","2024-10-22","2024-11-18","2024-11-04","2025-03-13","2025-10-21","2025-10-29","2025-08-26","2024-09-26","2024-09-26","2024-09-26","2024-09-26","2024-09-26","2024-07-25","2024-07-25","2024-07-25","2024-10-13","2024-10-08","2025-09-20","2025-08-27","2025-08-27","2025-08-27","2025-08-27","2023-01-11","2024-09-19","2024-06-24","2024-11-01","2025-11-04","2023-03-14","2024-11-18","2024-12-04","2024-11-18","2025-08-27","2025-05-21","2025-09-03","2025-11-05","2024-01-03","2024-01-03","2024-11-20","2025-09-03","2025-09-03","2025-09-03","2024-11-12","2024-11-15","2024-03-18","2024-08-23","2024-12-03","2024-12-03","2024-12-03","2024-01-12","2024-01-12","2024-06-12","2024-03-26","2024-04-21","2024-11-04","2024-10-25","2024-11-18","2024-11-13","2024-12-03","2025-03-13","2025-03-13","2024-11-15","2025-01-06","2024-03-26","2024-06-13","2024-10-25","2023-07-13","2023-01-11","2024-10-23","2024-10-23","2024-10-23","2024-03-14","2023-11-01","2024-02-15","2022-12-27","2022-12-27","2022-12-27","2022-12-27","2024-09-23","2024-02-27","2024-10-22","2025-03-04","2025-03-04","2025-03-04","2023-03-14","2023-03-14","2023-03-14","2025-01-23","2024-09-25","2024-03-18","2024-03-18","2023-11-09","2023-11-09","2023-11-09","2024-03-14","2024-03-14","2024-03-14","2024-03-14","2023-05-02","2023-05-02","2024-12-13","2024-10-22","2023-01-11","2025-02-06","2024-11-25","2024-11-25","2024-06-06","2024-11-01","2025-01-06","2022-11-19","2022-11-20","2022-10-31","2022-07-28"],"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":[["","","ELIQUIS","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","ENOXAPARIN SODIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","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":""}]}]}