{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Bertina M Page","gend":1,"currentgend":"","add":"4 TRUE RD","city":"Clinton","state":"ME","zip":"04927","dob":"1948-12-31","age":"","mstatus":"","insh":"10000029707","cliId":"","pno":2076493540,"cno":"","email":"","ename":"","eno":"","pphy":"DOUGLAS, JAMES W","ppno":"","pcpadd":"10 WASHINGTON ST,","pcpcity":"WATERVILLE","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE CLINTON","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"4 TRUE RD","madd2":"","madd3":"","mcity":"Clinton","mstate":"ME","mzip":"04927","pcpfaxno":"","pcpnpi":1760467187,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2HU4A45TE67","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D473","Z1231","M8589","E1151","U071","N184","I75021","C44311","L309","D485","L821","L720","D75839","Z7901","Z7964","N6321","I739","L818","J449","R0989","Z7982","R109","I129","N6489","I70203","I10","E1122","E119","Z08","R071","R0602","R4182","Z743","D696","N390","D72828","I743","Z0000","Z0101","E785","I2510","M79671","I998","Z87891","Z85828","Z1283","D229","R238","Z0001","G9389","R413","G319","Z86718","H2513","J189","H527","D3131","Q142","I75029","B9729","F0390","N289","Z1589","Z79899","Z0100","H5203"],"date":["2025-09-25","2025-05-22","2024-04-10","2023-01-25","2023-01-31","2025-02-24","2023-09-13","2023-02-27","2022-12-13","2022-12-13","2025-07-17","2022-12-13","2023-10-13","2023-12-28","2025-09-25","2025-08-26","2023-09-13","2023-09-13","2023-09-13","2024-04-12","2025-06-25","2024-04-12","2025-08-07","2025-05-23","2023-01-20","2023-01-21","2024-01-02","2024-04-08","2023-08-07","2025-08-07","2025-08-07","2025-08-07","2025-08-07","2023-06-08","2025-08-07","2023-09-08","2023-09-08","2024-04-02","2024-04-11","2025-03-04","2025-08-07","2023-01-21","2023-01-21","2024-06-05","2023-08-07","2024-01-16","2024-01-16","2024-01-16","2025-04-08","2025-08-07","2025-08-07","2025-08-07","2023-11-01","2025-11-11","2025-08-07","2025-08-19","2023-10-12","2023-10-12","2023-01-21","2023-01-21","2025-09-02","2023-12-13","2023-11-28","2023-11-28","2022-09-02","2022-09-02"],"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":[["","","HYDROXYUREA","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","RALOXIFENE HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","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":""}]}]}