{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Constance A Rowe","gend":1,"currentgend":"","add":"28 I ST","city":"Bangor","state":"ME","zip":"04401","dob":"1949-07-18","age":"","mstatus":"","insh":"10000034748","cliId":"","pno":2072171660,"cno":"","email":"declined@092424.com","ename":"","eno":"","pphy":"HATCH CLEIN, ANNETTE M","ppno":2079890550,"pcpadd":"43 WHITING HILL RD STE 300,","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121006","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"28 I ST","madd2":"","madd3":"","mcity":"Bangor","mstate":"ME","mzip":"04401","pcpfaxno":2079890551,"pcpnpi":1336189109,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7YJ9UH2XF29","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","I4891","Z4502","L4050","Z0101","Z79899","J069","R5383","D696","Z23","H40033","H2513","H43813","E119","E1140","M810","I2510","M79674","M79675","M2041","E079","E876","R194","R197","Z09","I421","R55","Z87891","M19071","M1812","M1811","M19072","M2012","Z713","L4059","L409","J449","M7989","R42","R112","R61","R0902","E213","R6889","R001","R778","G5601","M19049","R0789","R1013","E042","M180","E118","E041","R030","Z48812","I480","T82110A","I509","I472"],"date":["2024-02-15","2024-02-15","2025-07-25","2025-02-26","2025-04-11","2025-03-27","2024-03-14","2024-03-14","2023-11-29","2024-11-20","2024-08-05","2023-04-24","2023-04-24","2023-11-29","2025-07-22","2024-05-09","2024-09-21","2023-07-24","2023-07-24","2023-07-24","2025-03-27","2023-08-24","2023-08-24","2023-08-24","2022-11-02","2024-02-15","2022-11-02","2024-09-21","2023-09-05","2023-09-05","2023-09-05","2023-09-05","2023-09-05","2024-01-11","2025-03-27","2025-03-27","2022-10-23","2023-03-31","2022-10-23","2022-10-24","2022-10-23","2022-10-23","2024-05-20","2023-06-17","2023-01-18","2022-10-24","2025-03-27","2025-03-27","2023-01-18","2023-01-18","2024-06-06","2025-08-28","2025-03-27","2024-06-06","2024-05-09","2025-08-25","2022-12-19","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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","FREESTYLE LIBRE 3 SENSOR","","","Select","Select",""],["","","FREESTYLE LIBRE 3 READER","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","LEFLUNOMIDE","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","VERAPAMIL SR","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","VERAPAMIL ER","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","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":{"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":""}]}]}