{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Keith L Miller","gend":0,"currentgend":"","add":"128 NORTH ROAD","city":"Newburgh","state":"ME","zip":"04444","dob":"1950-10-08","age":"","mstatus":"","insh":"10000043564","cliId":"","pno":2072347213,"cno":2074780368,"email":"DAIRY128@GMAIL.COM","ename":"","eno":"","pphy":"RONCO, PAUL G","ppno":2079476141,"pcpadd":"43 WHITING HILL RD,SUITE 300","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121005","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"128 NORTH ROAD","madd2":"","madd3":"","mcity":"Newburgh","mstate":"ME","mzip":"04444","pcpfaxno":2079476720,"pcpnpi":1033152582,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7Y05AU9GK77","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","H8110","I214","Z1211","E1165","I252","R0602","M25512","Z98890","J392","R0789","E113292","Z86010","D122","H5203","H52223","H524","Z0101","K5730","R140","R0600","H04222","H11822","Z794","D649","M79661","M79662","I739","K635","K6389","E1151","R5383","R739","Z0000","G319","I2510","M2550","I6523","Z7982","Z79899","R42","Z0189","E669","Z6835","H348320","E119","H35022","I70213","Z125"],"date":["2025-03-20","2024-10-23","2024-11-19","2024-04-10","2025-03-20","2024-12-10","2024-11-11","2023-05-19","2025-01-09","2024-10-23","2024-10-23","2024-11-12","2024-04-10","2023-03-08","2024-12-12","2024-12-12","2024-12-12","2024-12-12","2023-03-08","2024-11-11","2024-11-15","2023-02-09","2023-02-09","2024-05-13","2023-06-19","2023-12-01","2023-12-01","2023-12-01","2024-04-10","2024-04-10","2022-12-14","2023-04-28","2022-12-08","2022-12-08","2024-06-20","2025-03-11","2024-05-13","2022-12-08","2023-04-05","2022-12-08","2024-06-20","2023-05-21","2025-03-20","2025-03-20","2023-12-15","2023-04-06","2023-12-15","2023-12-20","2022-06-15"],"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":[["","","CLOPIDOGREL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","FREESTYLE LIBRE 3 SENSOR","","","Select","Select",""],["","","FREESTYLE LIBRE 3 READER","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","IBU","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ULTRA-FINE MINI PEN NEEDLE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","DOXAZOSIN MESYLATE","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","QUINAPRIL HCL","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}