{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Laureen S Harriman","gend":1,"currentgend":"","add":"36 SEEKINS ST","city":"HARTLAND","state":"ME","zip":"04943","dob":"1951-08-30","age":"","mstatus":"","insh":"10000040507","cliId":"","pno":2079385877,"cno":"","email":"","ename":"","eno":"","pphy":"TOULOUSE, TIFFANY R","ppno":2074875154,"pcpadd":"SVH Family Care,470 Somerset Ave","pcpcity":"Pittsfield","pcpstate":"ME","pcpzip":"04967","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE NEWPORT","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 423","madd2":"","madd3":"","mcity":"HARTLAND","mstate":"ME","mzip":"04943","pcpfaxno":74873158,"pcpnpi":1932677416,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3FA4PK0MY08","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K5010","Z1231","R7303","H6643","M9903","M5136","M9904","M9905","Z0001","K5190","I10","H68003","Z0101","K529","Z86010","Z9049","E782","M8580","Z79899","H9191","K5090","Z8719","Z0000","H9201","Z13820","Z136","Z23","H6591","H6993","F17200"],"date":["2025-09-01","2025-11-05","2025-03-03","2023-07-19","2023-11-07","2023-11-07","2023-11-07","2023-11-07","2025-09-30","2025-08-28","2025-08-28","2025-08-28","2023-07-24","2023-05-04","2023-05-04","2023-05-04","2023-06-07","2023-06-07","2023-06-07","2023-10-11","2024-10-21","2024-05-23","2025-10-21","2023-06-07","2023-04-05","2023-04-05","2023-09-30","2023-07-31","2023-07-31","2023-07-31"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}