{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David D Bernard","gend":0,"currentgend":"","add":"34 MYRTLE ST","city":"MADISON","state":"ME","zip":"04950","dob":"1949-01-10","age":"","mstatus":"","insh":"10000033803","cliId":"","pno":2076325028,"cno":"","email":"ccsiconstruction@gmail.com","ename":"","eno":"","pphy":"Hannon, Gavin","ppno":2074657342,"pcpadd":"NORTHERN LIGHT HEALTH CENTER UNITY,80 MAIN ST","pcpcity":"UNITY","pcpstate":"ME","pcpzip":"04988","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HEALTH CENTER UNITY","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"34 MYRTLE ST","madd2":"","madd3":"","mcity":"MADISON","mstate":"ME","mzip":"04950","pcpfaxno":8606454151,"pcpnpi":1992327696,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8JX8XH3FQ38","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M9901","M47812","M9902","M9904","M542","M546","H2511","H2512","S8391XA","I4710","R002","R5383","R600","M7989","T7840XA","L309","R21","Z0100","R9720","N401","R351","Z8042","R0789","L239","Z9109","H527","Z961","I10","R000","J4521","J45909","T7840XS","J45901","H5789","R0981","Z13828","I77810","H04123","M25561","R030","G4700","R229","S838X1A","M19042","Y9329","Z9841","Z9842","Z114","Z1159"],"date":["2024-09-18","2024-09-18","2024-09-18","2024-09-18","2023-01-19","2023-01-19","2024-09-10","2024-09-03","2024-04-22","2025-01-08","2024-10-04","2024-10-04","2024-04-26","2024-05-14","2022-09-23","2022-12-21","2022-12-21","2024-03-08","2024-09-13","2024-09-13","2024-09-13","2024-09-13","2024-03-13","2022-10-31","2022-12-01","2024-10-08","2024-10-18","2024-08-12","2022-12-01","2022-12-01","2022-11-28","2022-12-01","2022-12-01","2022-12-13","2022-10-09","2024-06-05","2025-01-08","2025-05-05","2024-04-26","2022-12-13","2022-12-13","2022-12-13","2024-04-22","2024-05-14","2024-04-22","2025-03-27","2025-03-27","2024-06-05","2024-06-05"],"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":[["","","LEFLUNOMIDE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","FLUOROMETHOLONE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","ALCLOMETASONE DIPROPIONATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","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":""}]}]}