{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Eric J Elliott","gend":0,"currentgend":"","add":"526 HORSEBACK RD","city":"Clinton","state":"ME","zip":"04927","dob":"1962-01-13","age":"","mstatus":"","insh":"10000039185","cliId":"","pno":2074315291,"cno":"","email":"","ename":"","eno":"","pphy":"BARATTA, ELIZABETH A","ppno":2079737979,"pcpadd":"Northern Light Family Medicine and Residency,895 Union St Ste 12","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE CLINTON","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"526 HORSEBACK RD","madd2":"","madd3":"","mcity":"Clinton","mstate":"ME","mzip":"04927","pcpfaxno":2079479579,"pcpnpi":1740718261,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3RP8DR0MC51","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N200","L03116","S40012A","S8012XA","Z5321","L97821","S8012XD","V2999XD","R600","H5711","Z635","R0789","M79605","M79602","Z743","G894","M5416","M542","M79601","N401","Z466","G8929","G44001","R42","H547","R3915","R350","N529","Z23","L97823","E8342","J069","N138","Z79899","M25511","I96","L97929","H57813","M5412","M48062","K7030","H02403","F329","F1020","H02834","Z0101","H2513","H02831","M19011","N132","M25512","M47816","M47812","M4802","M75121","S43401A","M25411","M5030","L97909","E039","R319","R079","N400","F320","M109","R1310","G44009","R3911","I878","R109","Z87442","N201","R519","G629","K8020","Z79891","M5126","M7062","Z0000","M5450","F1019","S60221A","S81802A","H5203","H524","H52223","H40023","F339","T1511XA","G5601","G5621","F1120","E785","N2889","N320","G4700","S299XXA","L820","L538","L298","S4992XA","S59902A","M549","S3991XA","S3993XA","D485","F330","L97921","Z87828","E669","M7989","H02402","H02401","N3281","S20212A","S0990XA","R8289","C159","F1090","Z8501","H10501","H40013","H9209"],"date":["2024-07-09","2023-06-16","2023-05-18","2023-05-18","2023-04-24","2023-07-13","2023-07-13","2023-07-13","2023-07-13","2025-07-18","2025-07-18","2024-04-23","2024-04-23","2024-04-23","2024-04-23","2024-02-05","2025-02-19","2024-04-23","2024-12-08","2025-06-10","2024-01-30","2025-09-22","2024-09-11","2024-09-11","2024-09-11","2025-06-10","2025-06-10","2025-06-10","2022-12-07","2023-07-16","2025-07-23","2024-06-05","2025-02-18","2025-06-26","2024-10-10","2023-06-14","2023-06-10","2024-06-07","2025-02-26","2025-09-22","2025-09-02","2024-06-07","2025-06-16","2025-06-16","2024-02-06","2024-02-06","2024-02-06","2024-02-06","2024-12-08","2024-01-19","2023-05-18","2025-02-19","2024-12-08","2024-12-08","2025-01-15","2024-12-08","2024-12-08","2025-02-26","2023-06-14","2023-06-14","2023-08-17","2025-07-15","2022-12-16","2024-09-26","2024-09-26","2025-10-17","2024-10-17","2023-08-17","2023-08-16","2023-08-16","2023-12-08","2024-01-19","2023-05-24","2023-05-24","2023-01-30","2025-02-10","2023-06-27","2023-06-27","2025-04-11","2025-01-15","2025-07-15","2024-09-19","2023-06-11","2025-02-12","2025-02-12","2025-02-12","2025-02-12","2025-06-04","2024-03-28","2022-12-22","2022-12-22","2025-06-26","2025-06-27","2023-12-08","2023-12-08","2025-06-04","2024-04-23","2024-05-15","2024-05-15","2024-05-15","2023-05-18","2023-04-24","2025-02-19","2024-04-23","2024-04-23","2024-05-15","2025-04-01","2023-07-19","2023-07-19","2023-07-19","2023-05-18","2024-06-07","2024-06-07","2023-02-16","2024-04-23","2024-04-23","2022-12-16","2023-09-18","2025-06-02","2025-06-02","2025-09-12","2022-10-24","2022-09-29"],"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":[["","","TRAZODONE HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","XDEMVY","","","Select","Select",""],["","","BUPRENORPHINE","","","Select","Select",""],["","","DISULFIRAM","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","VERAPAMIL ER","","","Select","Select",""],["","","VERAPAMIL SR","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","DICLOFENAC SODIUM ER","","","Select","Select",""],["","","IBU","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","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":""}]}]}