{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Hugh R Williams","gend":0,"currentgend":"","add":"320 SOUTH BAY RD","city":"FRANKLIN","state":"ME","zip":"04634","dob":"1950-11-14","age":"","mstatus":"","insh":"10000043994","cliId":"","pno":2074220006,"cno":"","email":"HUGHWILL1950@GMAIL.COM","ename":"","eno":"","pphy":"CROWLEY, KERRY W","ppno":2079634066,"pcpadd":"50 UNION ST,ELEANOR WIDENER DIXON MEMORIAL CLINIC","pcpcity":"ELLSWORTH","pcpstate":"ME","pcpzip":"46051586","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE GOULDSBORO","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"72 TAUNTON DR","madd2":"","madd3":"","mcity":"SULLIVAN","mstate":"ME","mzip":"04664","pcpfaxno":2079637723,"pcpnpi":1679511075,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1QX9UN6WD19","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","N401","R9720","R351","Z8042","N421","I10","H40053","Z0100","Z0000","M85832","Z7189","Z1211","Z125","M457","R600","R310","K5730","K449","N400","N410","N411","M459","N138","Z98890","R3915","R350","N529","N3289","Z139","K5790","R6889","N3281","H353130","H2013","H3093","H35033","Z23","H30113","H43823"],"date":["2024-08-19","2025-05-16","2025-05-16","2025-05-21","2025-02-17","2023-04-07","2025-05-21","2024-08-14","2024-08-14","2025-01-06","2024-02-21","2025-01-06","2025-01-06","2025-01-06","2024-01-03","2025-05-21","2025-09-09","2025-09-09","2025-09-09","2025-09-09","2023-01-19","2023-04-07","2024-02-21","2025-05-16","2025-05-16","2023-07-20","2023-07-20","2023-03-03","2023-03-03","2023-07-20","2022-12-07","2022-08-30","2023-06-06","2024-03-13","2024-03-13","2024-03-13","2024-03-13","2025-03-07","2023-01-17","2023-01-17"],"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":[["","","CEPHALEXIN","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","ALFUZOSIN HCL ER","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","SIMPONI","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","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":""}]}]}