{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Louis Genova","gend":0,"currentgend":"","add":"21 ANSEL LN","city":"North Yarmouth","state":"ME","zip":"04097","dob":"1946-10-03","age":"","mstatus":"","insh":"10000031723","cliId":"","pno":2078293802,"cno":"","email":"ALFETTA@MAINE.RR.COM","ename":"","eno":"","pphy":"NEWCOMBE, JODI A","ppno":2075351200,"pcpadd":"385 ROUTE 1,","pcpcity":"YARMOUTH","pcpstate":"ME","pcpzip":"40966729","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE YARMOUTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"21 ANSEL LN","madd2":"","madd3":"","mcity":"North Yarmouth","mstate":"ME","mzip":"04097","pcpfaxno":2075351249,"pcpnpi":1114339611,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6CF1R42UH09","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I340","I2510","I10","R7309","F17290","E785","I252","I7121","Z0000","H53469","Z0001","H401121","H40021","I7120","N400","Z1211","D120","D122","D125","I080","H35373","H5213","H40013","H26493","R399","R3982","R197","R3989","R300","Z7982","H903","H7092","H53461","Z23","H524","H52203","I119","I25119","M25561","Z125"],"date":["2025-05-12","2025-06-12","2025-06-12","2025-05-13","2025-05-13","2025-05-16","2025-05-16","2024-05-09","2024-11-12","2024-10-21","2023-11-08","2025-05-09","2025-05-09","2023-11-08","2023-11-08","2025-01-09","2025-01-09","2025-01-09","2025-01-09","2024-03-13","2025-09-12","2024-09-19","2024-09-19","2023-11-20","2023-02-16","2023-02-16","2024-12-19","2022-12-13","2023-04-06","2024-12-19","2023-04-27","2024-10-21","2024-10-21","2022-10-28","2022-11-18","2022-11-18","2022-10-20","2022-10-20","2022-10-20","2022-10-19"],"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":[["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","BUDESONIDE DR","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","BUDESONIDE EC","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","ALFUZOSIN HCL 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":""}]}]}