{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan C Gray","gend":1,"currentgend":"","add":"22 REDINGTON ST APT 2","city":"Waterville","state":"ME","zip":"04901","dob":"1947-11-23","age":"","mstatus":"","insh":"10000030600","cliId":"","pno":2076805852,"cno":"","email":"susiekt1123@yahoo.com","ename":"","eno":"","pphy":"SCHLEICH, DEBORAH M","ppno":"","pcpadd":"Northern Light Primary Care Clinton,1309 Main St","pcpcity":"Clinton","pcpstate":"ME","pcpzip":"04927","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE CLINTON","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"22 REDINGTON ST APT 2","madd2":"","madd3":"","mcity":"Waterville","mstate":"ME","mzip":"04901","pcpfaxno":2078617056,"pcpnpi":1700331030,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3V13FD6HF83","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79671","J40","M9902","M9905","M9903","M9901","R32","N3281","M5450","S61011A","W458XXA","Z7982","R059","M5416","G8929","M542","M546","M9900","N3941","R600","M62838","R609","E6601","M19041","J029","I10","R7301","R7303","M9908","N393","E039","E669","S8992XA","R351","Z8673","Z1231","Z0000","Z0389","Z636","Z0101","M9904","M9907","R233","H538","Z0001","M67873","M19071","K219","E7800","M8580","Z1211","Z01818"],"date":["2024-10-04","2025-07-20","2025-10-21","2025-10-21","2025-10-21","2025-10-21","2023-06-19","2024-02-19","2024-04-16","2024-07-27","2024-07-27","2024-07-27","2025-07-30","2025-02-18","2024-01-23","2024-04-16","2024-04-16","2024-04-16","2023-08-21","2023-08-21","2024-04-16","2023-08-01","2024-04-09","2024-04-09","2025-07-30","2024-04-09","2024-03-01","2024-03-04","2024-03-05","2024-02-19","2023-08-01","2023-08-01","2023-08-01","2023-03-07","2023-03-07","2024-10-28","2023-11-28","2025-07-30","2023-04-24","2024-10-17","2023-11-15","2023-11-15","2023-06-19","2024-10-17","2024-09-16","2024-10-04","2024-10-04","2025-02-24","2022-12-13","2022-12-13","2025-02-24","2024-10-24"],"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":[["","","OMEPRAZOLE","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","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":""}]}]}