{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Priscilla A Pullen","gend":1,"currentgend":"","add":"32 SHERMAN DR APT 321","city":"ORONO","state":"ME","zip":"04473","dob":"1948-12-30","age":"","mstatus":"","insh":"10000032058","cliId":"","pno":2079512783,"cno":"","email":"declined@051225.com","ename":"","eno":"","pphy":"JURGENS, PAUL J","ppno":2079412373,"pcpadd":"Northern Light Husson Family Medicine,302 Husson Ave Ste 2","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HUSSON FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"32 SHERMAN DR APT 321","madd2":"","madd3":"","mcity":"ORONO","mstate":"ME","mzip":"04473","pcpfaxno":2079418803,"pcpnpi":1629590484,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9J04PV9EW96","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z21","B20","J209","L2089","R918","N281","R85615","D692","Z7952","Z0000","J439","N184","R0602","H6123","Z1211","I129","I739","R600","M76892","I10","G8929","F419","N1832","E559","E785","H26492","N6322","R0789","J324","H26491","H6593","K219","H43393","D72820","K5730","I671","M810","R1033","R6889","J984","J449","Z720","N644","K5909","R1030","N2889","H353130","E1122","H3530","H353211","H353122","Z5189","D649","F17210","R928","Z0101","L720","H353132","L309","R233","R911","H26493","H43813","Z09","R079","H04123","L821","D1801","L814","F32A","M549","Z1231","Z0121","I998","N189","M5136","M47817","M4180"],"date":["2025-08-26","2025-08-28","2025-06-24","2025-11-03","2025-05-05","2025-03-15","2025-05-14","2025-07-31","2025-07-31","2023-11-02","2023-11-02","2025-05-09","2025-06-24","2025-07-09","2023-03-09","2025-05-09","2025-05-16","2023-10-17","2023-11-30","2025-05-20","2023-11-30","2023-07-31","2025-05-20","2025-05-20","2025-05-20","2025-03-27","2024-10-25","2024-10-15","2025-06-24","2024-08-22","2025-07-09","2025-05-09","2024-07-10","2025-05-14","2022-12-26","2025-01-26","2025-03-03","2023-01-25","2023-08-24","2023-06-29","2023-06-29","2024-08-16","2024-10-16","2025-03-26","2022-12-26","2025-03-15","2025-04-16","2024-05-31","2025-03-04","2025-04-28","2025-04-28","2024-02-26","2025-10-14","2024-08-16","2024-10-25","2025-03-04","2023-12-21","2025-09-19","2025-11-03","2025-11-03","2023-02-01","2023-07-10","2023-07-10","2024-10-30","2024-10-14","2024-09-26","2022-12-21","2022-12-21","2022-12-21","2022-10-03","2022-10-03","2022-09-26","2022-08-18","2022-08-26","2022-07-14","2022-07-04","2022-07-04","2022-07-04"],"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":[["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","BUTALBITAL-ASPIRIN-CAFFEINE","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUGMENTED","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","BIKTARVY","","","Select","Select",""],["","","LINZESS","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","DOVATO","","","Select","Select",""],["","","TIVICAY","","","Select","Select",""],["","","PREZISTA","","","Select","Select",""],["","","RITONAVIR","","","Select","Select",""],["","","DARUNAVIR","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","DUPIXENT PEN","","","Select","Select",""],["","","TACROLIMUS","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","FLUOCINONIDE","","","Select","Select",""],["","","FLUZONE TRIVALENT 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","BUTALBITAL-ACETAMINOPHEN-CAFFE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","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":""}]}]}