{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia A Noble","gend":1,"currentgend":"","add":"1059 SHORE RD","city":"Lamoine","state":"ME","zip":"04605","dob":"1942-08-18","age":"","mstatus":"","insh":"10000042907","cliId":"","pno":2076642102,"cno":"","email":"declined@122920.com","ename":"","eno":"","pphy":"RENSENBRINK, KATHRYN","ppno":2076647780,"pcpadd":"Northern Light Primary Care Ellsworth,32 Resort Way","pcpcity":"Ellsworth","pcpstate":"ME","pcpzip":"04605","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1059 SHORE RD","madd2":"","madd3":"","mcity":"Lamoine","mstate":"ME","mzip":"04605","pcpfaxno":2076647721,"pcpnpi":1124067194,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7RM2WT5GA08","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M7062","M7061","M4807","Z79899","Z5181","I10","F3342","M159","H40013","H35373","H35033","H538","M7918","D500","G453","H348312","D509","Z7901","Z0000","D485","I480","H3411","L578","L905","L720","L738","M65331","D3132","C44519","D040","J9811","J984","M65332","R0600","J449","M1811","F325","R918","R7989","H26493","H34231","L821","D649","R0609","M5450","R040","I6522","M1611","G5701","R6889","Z95828","M7910","M5441","R0989","J189","G543","R059","Z8616","Z780","H35363","J342","Z8673","H43393","H401131","M8589","I679","M533","C44719","L570","Z7982","M47816","Z23"],"date":["2022-12-07","2023-01-12","2023-01-12","2023-01-12","2024-06-06","2024-09-16","2024-03-26","2024-03-26","2025-01-13","2025-08-04","2025-08-04","2023-12-01","2023-11-06","2025-06-23","2025-04-23","2025-04-23","2025-05-07","2025-07-11","2024-12-04","2024-07-29","2025-03-18","2023-06-30","2023-07-26","2023-07-26","2023-07-26","2023-01-23","2024-12-11","2025-04-23","2024-10-28","2024-10-21","2022-12-08","2022-12-08","2024-12-11","2022-12-28","2024-01-09","2024-07-19","2023-01-30","2023-01-30","2024-01-04","2022-11-21","2025-01-13","2023-07-26","2023-12-06","2022-11-14","2022-11-14","2025-07-11","2024-01-19","2023-07-19","2023-07-19","2023-10-12","2024-01-19","2023-10-04","2023-05-31","2022-11-01","2022-11-01","2023-05-03","2022-11-01","2022-11-01","2023-11-07","2023-01-17","2025-07-11","2025-07-11","2025-08-04","2025-08-04","2023-11-07","2022-09-12","2022-09-07","2022-08-25","2022-07-22","2022-08-02","2022-07-13","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":[["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","TRIAMTERENE-HYDROCHLOROTHIAZID","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","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":""}]}]}