{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David Lovely","gend":0,"currentgend":"","add":"1709 STATE RD","city":"Mapleton","state":"ME","zip":"04757","dob":"1949-11-28","age":"","mstatus":"","insh":"10000041765","cliId":"","pno":2077646324,"cno":"","email":"","ename":"","eno":"","pphy":"MACHARIA, THOMAS C","ppno":2077643142,"pcpadd":"146 ACADEMY ST,","pcpcity":"PRESQUE ISLE","pcpstate":"ME","pcpzip":"47693102","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE MARS HILL","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 108","madd2":"","madd3":"","mcity":"Mapleton","mstate":"ME","mzip":"04757","pcpfaxno":2077608170,"pcpnpi":1881853919,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5EF7RY5NG78","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z471","C661","Z96611","C679","S43004A","W009XXA","S43004D","H903","X58XXXD","D090","C672","S43141A","W000XXA","Y9389","Z87891","Z08","Z8551","C674","Z96651","C689","M75121","M2540","Z79899","R9720","E782","I10","G8929","R82998","Z01818","M75101","S46091A","W19XXXA","Z0001","H9313","H6123","Z77122","Z23","Z466","D494","R310","N329","R319","R8271","R9389"],"date":["2024-07-31","2022-12-23","2024-05-29","2024-06-17","2024-01-16","2023-12-01","2024-02-02","2025-01-02","2023-12-15","2023-04-27","2024-12-31","2023-11-25","2023-11-25","2023-11-25","2024-05-13","2024-05-07","2024-05-07","2023-04-04","2024-07-31","2024-03-25","2024-05-16","2024-01-19","2024-05-13","2024-12-31","2024-12-31","2024-12-31","2024-01-08","2023-07-10","2024-02-15","2024-04-04","2024-05-13","2024-05-13","2024-12-31","2025-01-02","2025-01-02","2025-01-02","2024-09-16","2022-08-26","2022-07-29","2022-07-29","2022-07-29","2022-07-02","2022-07-02","2022-07-02"],"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":[["","","NAPROXEN","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","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":""}]}]}