{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marnela I Haskell","gend":1,"currentgend":"","add":"88 SMITH RD","city":"PALMYRA","state":"ME","zip":"04965","dob":"1951-01-26","age":"","mstatus":"","insh":"10000030765","cliId":"","pno":2078371671,"cno":2078371605,"email":"marniehask@gmail.com","ename":"","eno":"","pphy":"TAGUE, COURTNEY","ppno":2078664399,"pcpadd":"EMMC Orono Family Medicine,84 Kelley Rd","pcpcity":"Orono","pcpstate":"ME","pcpzip":"04473","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"88 SMITH RD","madd2":"","madd3":"","mcity":"PALMYRA","mstate":"ME","mzip":"04965","pcpfaxno":2078664538,"pcpnpi":1679953194,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9CT0FH5DT27","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R682","I214","H40043","H2513","H25013","E119","F3181","F419","Z79899","K7460","H4010X4","E1165","C8319","Z803","Z801","E042","M47816","G629","M4316","M2578","E6601","F4310","K521","K5730","M9903","M51362","M9904","M9905","R0789","C8318","Z1231","R2689","R279","E109","Z780","R0600","R55","G4733","C8313","R300","T2122XA","E871","E139","E876","M4726","K921","I8510","K7581","M9901","M5382","M9902","M546","I110","I5030","E785","I480","I130","R059","K520","M47817","Z7982","J189","M5416","M48061","M5117","M5116","M4727","Z452","J411","S40012A","K760","K317","S0990XA","W19XXXA","H401131","G620","I5032","C8310","D649","R911","N289","Z952","R9431","R278","L820","L298","R208","L570","I5033","I2510","Z87440","I071","I2720","J101","C8311","L814","L821","D1801","L718","E039","Z713","Z794","Z7984","I21A1","D61818","N281","Z8572","J90","I6521","Z7901","D485","E1365","Z0000","Z923","I509","R600","J069","G5602","R1011","I361","R197","K219","L290","H109","C6981","T50905A","Z98890","R69","K3189","H2511","H401111","H029","L853","R519","K2950","Z1152","M1812","Z09","Z8673","Z8669","E11649","I10","Z1211","I493","S0501XA","E1322","Z08","I350","J45909","R0602","Z743","J441","J09X2","M940","C8590","R0982","Z9221","I639","H2512","H401121","Z630","K319","K6289","Z1289","M4802","M5021","M50321","M47812","D489","M79604","S299XXA","S3991XA","S3993XA","Z510","S4992XA","N3010","R222","S199XXA","K644","H538","Z6841","I25119","M1A9XX0","S7292XA","M542","S79912A","M25512","R319","S7002XA","R6889","U071","W1839XA","Y939","R918","K922","R748","R21","K641","K5289","K623","R270","R531","Z9049","R109","R161","I4891","I517","K589","R0609","R002","N2889"],"date":["2023-01-19","2025-06-23","2023-01-04","2023-08-17","2023-01-04","2025-09-24","2025-10-17","2025-10-17","2025-09-26","2025-04-24","2023-12-20","2024-12-30","2025-08-26","2025-08-26","2025-08-26","2024-12-16","2024-07-16","2024-12-17","2023-06-20","2023-06-20","2024-02-26","2025-10-17","2024-10-02","2024-03-24","2025-10-27","2025-10-27","2025-10-27","2025-10-27","2025-06-20","2025-08-07","2024-11-26","2024-07-29","2024-06-26","2025-10-23","2025-01-21","2025-09-23","2025-11-13","2025-10-09","2024-10-14","2023-07-07","2023-06-27","2025-11-17","2025-11-17","2025-11-17","2024-02-14","2022-11-29","2022-11-29","2023-08-23","2024-11-04","2024-11-04","2024-11-04","2025-01-14","2025-11-11","2025-06-30","2025-09-24","2025-07-11","2025-10-30","2025-03-28","2024-07-10","2024-02-14","2025-07-08","2024-11-17","2025-05-01","2024-03-16","2024-03-16","2024-03-16","2024-03-16","2023-10-13","2025-03-28","2024-09-05","2023-07-26","2025-02-24","2024-09-05","2024-09-05","2025-11-13","2024-04-19","2025-11-18","2025-02-26","2023-05-12","2024-06-27","2023-01-23","2023-06-16","2025-11-14","2024-07-22","2023-03-29","2023-03-29","2023-03-29","2023-03-29","2025-07-11","2025-07-11","2024-09-23","2023-06-16","2023-06-16","2025-03-23","2025-04-15","2023-03-29","2023-03-29","2023-03-29","2023-06-27","2025-09-09","2024-06-27","2024-06-27","2024-06-27","2025-06-23","2025-06-23","2024-09-23","2025-08-07","2025-07-08","2025-07-08","2025-07-08","2024-05-08","2025-11-06","2024-08-29","2024-08-16","2025-10-30","2025-09-23","2024-11-17","2025-04-02","2025-11-01","2025-05-08","2025-02-19","2023-08-23","2022-12-08","2025-09-25","2024-11-14","2025-11-13","2023-05-23","2024-04-04","2023-07-26","2023-12-06","2023-12-06","2024-07-22","2023-01-19","2024-06-28","2024-08-13","2024-02-15","2024-08-29","2024-11-06","2024-11-06","2024-11-06","2023-06-07","2025-04-22","2025-02-24","2023-02-23","2024-02-27","2025-10-16","2025-01-15","2025-06-23","2025-06-23","2025-07-07","2025-06-20","2025-03-23","2025-03-23","2025-03-23","2023-10-13","2023-10-06","2023-10-06","2025-02-17","2023-12-20","2023-12-20","2025-08-27","2025-02-24","2024-08-13","2025-04-24","2024-07-29","2024-07-29","2024-07-29","2024-07-29","2024-05-08","2024-03-16","2024-09-05","2024-09-05","2024-09-05","2024-08-05","2024-09-05","2025-01-27","2024-03-20","2024-09-05","2022-12-08","2024-06-28","2024-02-26","2022-11-18","2022-11-18","2022-11-07","2022-11-07","2022-11-07","2022-11-07","2022-11-04","2022-11-07","2022-11-13","2022-10-25","2022-11-07","2022-11-07","2022-10-12","2022-07-13","2022-06-22","2022-06-22","2022-05-26","2022-05-06","2022-05-06","2022-05-06","2022-05-06","2022-04-27","2022-04-27","2022-04-27","2022-04-18","2022-04-18","2022-04-14","2022-03-11","2022-03-11","2022-04-04"],"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":[["","","GLIPIZIDE ER","","","Select","Select",""],["","","BUMETANIDE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ARIPIPRAZOLE","","","Select","Select",""],["","","XIFAXAN","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","NOVOLIN N FLEXPEN","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","ADVAIR HFA","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","VERAPAMIL SR","","","Select","Select",""],["","","ULTRA-FINE SHORT PEN NEEDLE","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","ULTRA-FINE PEN NEEDLE","","","Select","Select",""],["","","VERAPAMIL ER","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","INSULIN ASPART FLEXPEN","","","Select","Select",""],["","","NOVOLIN N","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","ZEGALOGUE AUTOINJECTOR","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","FREESTYLE LIBRE 3 SENSOR","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","METOLAZONE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","TOBRAMYCIN-DEXAMETHASONE","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FREESTYLE FREEDOM LITE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","SANDOSTATIN LAR DEPOT","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","REXULTI","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","INSULIN SYRINGE","","","Select","Select",""],["","","OCTREOTIDE ACETATE","","","Select","Select",""],["","","ULTRA-FINE ORIGINAL PEN NEEDLE","","","Select","Select",""],["","","DIPHENOXYLATE-ATROPINE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}