{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marie E Hardie","gend":1,"currentgend":"","add":"343 NORTH DEER ISLE ROAD","city":"Deer Isle","state":"ME","zip":"04627","dob":"1950-02-26","age":"","mstatus":"","insh":"10000039893","cliId":"","pno":2074604754,"cno":2073486803,"email":"dbnanna@myfairpoint.net","ename":"","eno":"","pphy":"FUSCO, ANTHONY L","ppno":2073672311,"pcpadd":"354 Airport Rd,","pcpcity":"Stonington","pcpstate":"ME","pcpzip":"04681","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE STONINGTON","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"343 NORTH DEER ISLE ROAD","madd2":"","madd3":"","mcity":"Deer Isle","mstate":"ME","mzip":"04627","pcpfaxno":2073672805,"pcpnpi":1396157376,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2W03D93QR01","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5416","C50912","M7918","C50911","Z170","M810","Z79811","M5450","U071","R519","E876","I110","J329","Z1721","Z1732","I319","Z1231","C50919","M7061","G8929","Z791","I509","I351","I10","M5136","M7020","R053","R55","E785","H04123","H16103","C50811","M4726","Z79891","R079","Z0000","E538","M85851","M85852","Z79899","Z7982","Z13820","M51369","M5116","T50905A","F411","Z87891","Z923","D649","J449","R0789","Z7183","Z800","R112","C50812","J0190","Z98890","M549","S0990XA","I5181","I429","R059","Z853","Z8371","C50412","I309","I213","Z0001","E039","M8580","R6889","M533","R922","Z780","R928","L723","M48061","R0781","H43812","M47816","Z510","N3001"],"date":["2024-03-27","2025-07-16","2023-08-31","2024-01-09","2025-02-06","2023-06-07","2024-07-17","2023-09-20","2022-10-20","2022-10-20","2022-10-20","2025-03-20","2023-01-06","2025-02-06","2025-02-06","2024-08-11","2025-01-27","2023-06-07","2023-06-14","2023-05-30","2023-08-31","2025-08-19","2025-08-19","2025-06-12","2024-02-24","2024-05-09","2023-09-21","2024-08-17","2024-11-27","2024-12-16","2024-12-16","2022-10-14","2024-05-07","2023-08-31","2024-09-23","2023-12-06","2025-03-13","2023-12-08","2025-01-10","2023-03-16","2022-11-15","2023-12-08","2025-06-26","2025-06-26","2024-08-17","2024-10-01","2022-10-14","2024-01-09","2023-02-23","2024-08-30","2024-08-30","2023-05-10","2023-05-10","2025-08-01","2024-02-01","2023-11-16","2023-01-27","2024-06-12","2024-08-17","2024-08-13","2024-09-09","2023-05-03","2023-04-05","2023-04-05","2023-03-30","2024-08-11","2024-08-11","2024-12-02","2025-06-19","2024-07-17","2022-09-29","2022-09-26","2022-09-27","2022-09-27","2022-09-07","2022-08-16","2022-09-08","2022-08-15","2022-07-19","2022-07-27","2022-06-01","2022-06-17"],"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":[["","","CLOPIDOGREL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","EXEMESTANE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","COLCHICINE","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","XIIDRA","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","ANASTROZOLE","","","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":""}]}]}