{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Linda Stearns","gend":1,"currentgend":"","add":"14 FISHERMANS LN","city":"RAYMOND","state":"ME","zip":"04071","dob":"1949-09-18","age":"","mstatus":"","insh":"10000035599","cliId":"","pno":2076936095,"cno":"","email":"ljstearns@roadrunner.com","ename":"","eno":"","pphy":"Campbell, Corinna M","ppno":2074008600,"pcpadd":"ST MARYS REGIONAL MEDICAL CENTER PB,791 TURNER ST","pcpcity":"AUBURN","pcpstate":"ME","pcpzip":"04210","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"14 FISHERMANS LN","madd2":"","madd3":"","mcity":"RAYMOND","mstate":"ME","mzip":"04071","pcpfaxno":2077836660,"pcpnpi":1043720667,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5XY1VW4GJ15","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M19012","M25712","M25512","G8929","Z01810","R1012","I700","Z471","Z96611","I10","I77810","E785","S46091A","M25511","K219","G8918","K2970","K5900","Z96619","J180","M19011","Z98890","Z01818","M25411","Z0000","I340","E119","E039","R109","Z1231","S43421D","M25711","R7303","D649","Z0101","M75121","S80862A","R6889"],"date":["2025-05-05","2025-05-05","2025-06-04","2025-06-04","2025-06-09","2024-06-08","2024-06-08","2024-08-01","2024-08-01","2025-06-10","2024-06-05","2024-06-05","2022-08-30","2024-06-06","2024-06-06","2024-06-06","2024-06-08","2024-06-08","2024-06-08","2024-12-07","2024-08-01","2022-10-27","2024-05-22","2024-05-06","2024-07-24","2024-05-21","2022-09-26","2022-09-14","2024-06-08","2024-09-06","2022-08-30","2023-06-13","2024-10-24","2024-10-14","2023-09-29","2022-08-30","2024-05-29","2023-10-02"],"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":[["","","LOSARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","TRUE METRIX GLUCOSE TEST STRIP","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","CAREONE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","TRUE METRIX BLOOD GLUCOSE MTR","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","EUTHYROX","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","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":""}]}]}