{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Willis N White","gend":0,"currentgend":"","add":"541 BAYSIDE RD","city":"Ellsworth","state":"ME","zip":"04605","dob":"1947-09-16","age":"","mstatus":"","insh":"10000037679","cliId":"","pno":2076672135,"cno":"","email":"declined@040824.com","ename":"","eno":"","pphy":"HIGGINS, MARTIN","ppno":"","pcpadd":"Northern Light Primary Care,","pcpcity":"Ellsworth","pcpstate":"ME","pcpzip":"04605","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"541 BAYSIDE RD","madd2":"","madd3":"","mcity":"Ellsworth","mstate":"ME","mzip":"04605","pcpfaxno":"","pcpnpi":1851917751,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5UR5RN5JA62","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z8639","J069","Z5181","N2889","M1712","I82409","I5021","E1121","K8020","Z1211","Z86010","K5140","T148XXA","E1165","C642","E119","E6601","R399","K5730","J9811","Z85118","C649","Z86718","E876","T8149XA","N390","J439","R0609","T1512XA","Z1152","I428","N184","I10","E875","D649","J40","H5712","H40052","H35412","I129","H25093","H02831","H02834","N1832","Z96651","T8189XA","E1122","I5022","R059","R062","Z7901","N179","R079","I209","K810","N1830","Z23","I2510","I130","I5023","N182","R1011","N323","Z299","N1831","E871","R748","I5020","H40053","Z483","I509","Z77098","Z87891","K838","J90","R0600","R7989","R0989","E785","R071","I5043","Z0000","Z01818","E1140","R0602","D469","M1711","K219","H9313","H3561","Z48816","R6889","Z85528","R918","I2720","R1900","Z79899","R350","I214","K819","Z743","I422","I517","H527"],"date":["2024-10-21","2024-01-04","2025-05-16","2024-06-23","2025-05-23","2025-08-28","2025-04-28","2025-06-03","2024-06-17","2023-05-16","2023-05-16","2023-05-16","2024-07-22","2025-07-24","2025-05-12","2025-01-16","2025-07-24","2025-07-17","2024-11-27","2025-05-02","2025-05-02","2025-05-02","2024-10-07","2024-12-13","2024-09-21","2025-08-21","2025-07-18","2024-10-04","2024-01-10","2024-01-04","2024-04-25","2025-06-23","2025-06-23","2025-06-23","2025-01-29","2025-07-08","2024-01-10","2025-05-15","2025-05-15","2025-06-12","2025-05-15","2025-05-15","2025-05-15","2025-05-02","2025-05-23","2024-07-29","2025-08-12","2025-04-01","2025-07-08","2025-07-08","2025-09-02","2024-09-27","2024-08-13","2024-08-12","2024-08-10","2024-11-22","2024-11-18","2023-11-08","2023-11-08","2023-11-08","2023-11-08","2024-08-14","2024-08-10","2023-02-01","2024-08-16","2024-08-16","2024-08-10","2024-04-25","2024-04-25","2024-07-23","2025-07-01","2024-05-13","2024-05-13","2024-08-12","2024-08-12","2024-08-12","2024-08-12","2024-08-10","2024-11-15","2024-08-10","2024-04-26","2025-03-13","2024-06-03","2023-10-11","2023-09-30","2025-03-10","2022-11-30","2024-09-12","2025-06-03","2023-04-20","2024-08-07","2022-10-25","2025-01-13","2024-11-27","2023-10-17","2024-08-18","2024-01-15","2025-07-10","2024-08-13","2024-08-13","2024-08-13","2024-04-25","2024-04-25","2022-10-19"],"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",""],["","","CARVEDILOL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ALCOHOL PREP PADS","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","LOKELMA","","","Select","Select",""],["","","UNILET LANCETS","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","SPS","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","GLUCOCARD VITAL","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","MODERNA 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":{"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":""}]}]}