{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Roland A Morin","gend":0,"currentgend":"","add":"14 WAGON WHEEL LN","city":"Falmouth","state":"ME","zip":"04105","dob":"1950-07-26","age":"","mstatus":"","insh":"10000041212","cliId":"","pno":2072722608,"cno":"","email":"rolandmorin@hotmail.com","ename":"","eno":"","pphy":"LANE, MEGAN E","ppno":2075351340,"pcpadd":"66 LEIGHTON RD,","pcpcity":"FALMOUTH","pcpstate":"ME","pcpzip":"41052225","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE WEST FALMOUTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"14 WAGON WHEEL LN","madd2":"","madd3":"","mcity":"Falmouth","mstate":"ME","mzip":"04105","pcpfaxno":2078788797,"pcpnpi":1831103647,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4YE8R63NM31","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C73","M542","I428","R7401","N2889","R059","I3489","I081","I77810","I501","K8020","K5730","M7741","M79671","R509","R21","Z20822","K4090","Z79899","L821","L219","L814","D1801","E039","L820","K4020","K8689","I340","I5030","M720","Z23","D3000","D72819","I4891","E042","K219","R0602","E7800","K862","I2699","R918","Z01818","Z0000","D3611","D179","E785","E890","I2510","Z136","R600","M79642","S90222A","I10","L729","R490","Z1211","E041","Z79890","Z0001","I429","D485","Z5181","I4720","N503","Z0101","H40013","B079","D229","L308","D171","I440","Z9089","I7121","G4700","R6889","Z8042","Z803","D701","I472","B351","M47812","R1310"],"date":["2025-09-10","2023-05-19","2025-07-07","2024-08-29","2025-11-05","2024-08-29","2023-12-12","2025-06-30","2025-06-30","2025-06-30","2024-12-02","2024-12-02","2024-03-11","2024-03-11","2024-08-29","2024-08-29","2024-08-29","2025-07-29","2025-07-29","2024-12-23","2022-12-15","2023-10-30","2024-12-23","2025-08-18","2025-09-22","2025-08-07","2025-08-24","2023-01-04","2023-01-04","2024-08-16","2023-11-08","2023-07-12","2023-05-17","2023-05-17","2025-09-10","2023-02-08","2022-12-01","2025-06-26","2024-12-02","2023-05-15","2022-11-29","2023-12-12","2024-10-21","2023-08-17","2025-06-16","2024-10-21","2025-08-13","2024-07-01","2024-06-27","2024-07-09","2024-07-09","2023-12-18","2024-10-21","2025-02-19","2023-07-12","2023-11-09","2025-08-13","2025-08-13","2025-10-14","2025-02-07","2023-08-17","2024-02-08","2025-02-07","2025-02-07","2024-11-14","2024-11-14","2023-06-05","2023-06-05","2023-03-27","2023-03-27","2022-12-12","2023-06-06","2023-06-12","2022-10-24","2022-10-14","2022-09-28","2022-09-28","2022-08-17","2022-08-08","2022-09-08","2022-07-07","2022-07-06"],"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":[["","","XARELTO","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","SODIUM FLUORIDE 5000 PLUS","","","Select","Select",""],["","","XIAFLEX","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","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":""}]}]}