{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Stanley E Folsom","gend":0,"currentgend":"","add":"27 BUTTER ST","city":"GUILFORD","state":"ME","zip":"04443","dob":"1949-06-20","age":"","mstatus":"","insh":"10000033673","cliId":"","pno":2078763183,"cno":"","email":"folsomtwo@myfairpoint.net","ename":"","eno":"","pphy":"KNOWLTON, LUCAS T","ppno":2078764811,"pcpadd":"4720 S I 10 SERVICE RD W STE 301,","pcpcity":"METAIRIE","pcpstate":"LA","pcpzip":"70001124","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE SANGERVILLE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"27 BUTTER ST","madd2":"","madd3":"","mcity":"GUILFORD","mstate":"ME","mzip":"04443","pcpfaxno":5048857642,"pcpnpi":1205119831,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6G23W67QR83","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R809","M5431","H25812","H04123","H02125","L570","D225","L821","L814","Z7189","H527","H532","H40013","Z0000","C44212","M47816","I788","Z08","R0781","M5450","E790","R350","M51369","H04223","H04522","H04521","H04563","D485","I350","H16223","H04203","W19XXXA","Z87891","Z9841","Z9842","H25811","M9900","I77810","I5189","Z1211","M109","M19042","M7989","M65312","H02102","H02105","R300","S30860A","M5136","S39012A","K621","Z0101","H524","H2513"],"date":["2025-01-14","2023-07-27","2024-11-19","2024-05-03","2023-05-23","2025-07-30","2025-07-30","2025-07-30","2025-07-30","2025-07-30","2024-05-03","2025-05-27","2025-05-16","2025-04-01","2024-02-12","2025-01-29","2024-01-12","2024-01-12","2025-04-07","2025-01-03","2023-04-25","2025-01-13","2025-02-03","2024-01-29","2023-10-24","2023-10-24","2024-01-29","2024-01-12","2025-08-05","2023-06-26","2023-06-26","2025-04-07","2025-04-04","2025-01-29","2025-01-29","2024-12-02","2023-02-01","2025-06-04","2025-06-04","2024-05-06","2023-10-11","2023-10-13","2023-10-13","2023-11-27","2024-01-29","2024-01-29","2025-01-16","2025-05-19","2023-01-11","2023-01-04","2024-05-06","2022-09-22","2022-09-22","2022-09-22"],"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":[["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","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":""}]}]}