{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Richard W Roy","gend":0,"currentgend":"","add":"23 NEAL RD","city":"WINDHAM","state":"ME","zip":"04062","dob":"1942-01-11","age":"","mstatus":"","insh":"10000042794","cliId":"","pno":2073218725,"cno":"","email":"none@none.com","ename":"","eno":"","pphy":"Lavallee, Heather A","ppno":2078930290,"pcpadd":"100 FODEN ROAD,WEST BUILDING SUITE 103","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41062351","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"23 NEAL RD","madd2":"","madd3":"","mcity":"WINDHAM","mstate":"ME","mzip":"04062","pcpfaxno":2078930295,"pcpnpi":1841569720,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2MJ8NA0YA36","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N210","E039","I10","I4891","H2512","H02833","H02836","H5213","Z96651","Z471","M25661","R262","J189","M1711","R42","Z0000","R140","M7631","I4821","N401","Z87442","K5730","N200","K4090","N281","N390","N3289","R059","H6590","K219","Z1152","R3914","H2511","Z01818","G8918","E119","H2513","Z043","M19022","H269","S5002XA","U071","Z961","H43813","N138","N323","N400","R935","R319","Z7901","R310","R339","H40032","R399","H524","S70261A"],"date":["2025-05-05","2024-03-25","2024-02-14","2023-06-29","2023-05-09","2025-02-13","2025-02-13","2022-12-15","2024-09-12","2024-05-09","2024-04-16","2024-04-16","2024-01-22","2024-12-16","2024-02-06","2024-07-01","2023-12-22","2024-12-16","2025-03-31","2025-05-29","2024-05-09","2023-12-22","2025-05-29","2023-12-22","2023-12-22","2023-12-22","2023-12-22","2024-01-27","2024-01-27","2024-03-25","2024-01-27","2024-11-08","2022-07-26","2024-03-12","2024-03-25","2022-07-12","2022-07-26","2022-07-13","2022-07-13","2022-07-26","2022-07-13","2022-09-26","2025-02-13","2025-02-13","2025-05-29","2025-05-14","2025-05-14","2023-03-24","2023-05-20","2023-04-07","2023-03-08","2023-05-20","2023-03-16","2023-05-02","2022-06-29","2022-06-17"],"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":[["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","DIFLUPREDNATE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","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":""}]}]}