{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patrick D Sturtevant","gend":0,"currentgend":"","add":"75 HALIFAX ST UNIT D32","city":"Winslow","state":"ME","zip":"04901","dob":"1950-08-16","age":"","mstatus":"","insh":"10000042109","cliId":"","pno":2076715167,"cno":2076715167,"email":"patricksturtevant@yahoo.com","ename":"","eno":"","pphy":"FAGLES, NINA E","ppno":2079890550,"pcpadd":"84 KELLEY RD,","pcpcity":"ORONO","pcpstate":"ME","pcpzip":"44733416","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"75 HALIFAX ST UNIT D32","madd2":"","madd3":"","mcity":"Winslow","mstate":"ME","mzip":"04901","pcpfaxno":"","pcpnpi":1124069851,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7UM3Y56CY87","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R531","M1712","D509","M25562","N529","K219","Z860100","Z87891","G588","Z96652","M25569","R7303","Z139","N400","E291","I6523","F321","N312","R6889","H833X3","H9113","Z0100","K259","N3943","I7140","Z0000","M25571","M6281","R279","R262","Z23","Z713","R739","D3610","M25561","Z96651","R790","H35373","E785","Z0101","Z471","M5432","Z79899","Z0001","D225","D649","D229","M7052","R94131","K2980","H5462","E119"],"date":["2025-08-20","2023-06-06","2025-08-20","2025-11-04","2025-06-04","2025-05-22","2025-01-20","2025-01-20","2025-10-15","2025-10-19","2025-10-21","2024-05-24","2024-05-07","2024-05-07","2025-05-07","2024-11-14","2023-03-07","2025-10-20","2023-08-28","2023-03-16","2023-03-16","2024-05-01","2024-12-10","2024-04-19","2024-05-16","2024-03-20","2025-06-27","2025-06-27","2025-06-27","2025-06-27","2024-03-20","2022-12-05","2024-11-07","2023-05-17","2025-10-07","2025-10-07","2025-05-07","2023-07-20","2023-12-05","2025-06-05","2025-10-19","2023-05-25","2024-05-16","2025-05-12","2024-05-16","2024-09-12","2024-05-16","2023-03-13","2025-07-16","2024-12-10","2024-11-14","2022-11-02"],"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":[["","","ESOMEPRAZOLE MAGNESIUM","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","BETHANECHOL CHLORIDE","","","Select","Select",""],["","","JATENZO","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}