{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Martin A Brown","gend":0,"currentgend":"","add":"58 NELSON ST","city":"BANGOR","state":"ME","zip":"04401","dob":"1950-07-01","age":"","mstatus":"","insh":"10000041305","cliId":"","pno":2079418955,"cno":"","email":"Martin.brown@verizon.net","ename":"","eno":"","pphy":"KEITH, ALLISON C","ppno":2079412373,"pcpadd":"43 WHITING HILL RD,SUITE 300","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121005","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HUSSON FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 2545","madd2":"","madd3":"","mcity":"BANGOR","mstate":"ME","mzip":"04402","pcpfaxno":2079735042,"pcpnpi":1285013771,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5DE8KU6UY41","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D649","I10","E039","Z125","M6588","H353112","Z0000","H353133","M5440","M5412","K529","H353132","H2513","M5416","R079","H33322","Z79899","H9202","K1379","R6884","R9720","R197","R350","M0600","N401","R3915","N529","G4700","D509","M1712","M25562","M19172","M50123","H538","M19072","M79672","Z0001","Z0101","R7989","R351","S39011A","H25813","X58XXXA","Y939","Y929","E785","G8929","M25551","M5431","M159","R600","K5909","M19079","K589","I080","M25569","H6123","I119","M79676","M205X2","M069","M549","M06062","M7989","S90859A","I5030","E041","M47816","M5117","M4727","M4316","H2511","R32","K5900","K5730","M50122","M23322","F4542"],"date":["2023-01-04","2025-07-29","2023-11-14","2023-06-08","2024-11-06","2025-02-10","2023-06-08","2025-08-19","2023-08-16","2025-06-13","2025-06-20","2025-06-24","2025-06-24","2025-09-10","2025-09-08","2025-05-15","2025-05-15","2025-07-29","2025-07-25","2025-07-25","2025-03-10","2025-09-05","2025-08-12","2023-06-20","2025-08-12","2025-08-12","2025-08-12","2022-12-13","2022-12-13","2025-04-15","2025-04-15","2025-04-15","2023-10-05","2023-01-25","2025-01-08","2025-01-08","2025-07-14","2025-05-06","2024-03-22","2024-07-16","2023-05-03","2024-07-31","2023-05-03","2023-05-03","2023-05-03","2024-05-28","2024-06-02","2023-05-11","2023-05-18","2024-05-28","2024-02-01","2023-11-01","2023-11-01","2024-09-24","2024-02-01","2024-09-06","2023-10-13","2024-07-11","2023-11-14","2024-07-10","2023-05-18","2023-05-18","2024-08-21","2023-11-14","2023-11-14","2024-05-06","2024-07-11","2023-07-07","2023-07-07","2023-07-07","2023-07-07","2024-09-03","2023-05-25","2023-05-25","2023-05-03","2024-03-21","2024-09-06","2023-08-16"],"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":[["","","TERAZOSIN HCL","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","COLESTIPOL HCL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","SOLIFENACIN 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":""}]}]}