{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Edmund A Cyr","gend":0,"currentgend":"","add":"25 HIGHLAND AVE","city":"OLD TOWN","state":"ME","zip":"04468","dob":"1950-12-28","age":"","mstatus":"","insh":"10000045086","cliId":"","pno":2078273692,"cno":"","email":"edmundc485@aol.com","ename":"","eno":"","pphy":"JOHNSTON, PAULINE K","ppno":"","pcpadd":"43 WHITING HILL RD STE 300,","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121006","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"25 HIGHLAND AVE","madd2":"","madd3":"","mcity":"OLD TOWN","mstate":"ME","mzip":"04468","pcpfaxno":2079735042,"pcpnpi":1598705360,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4QD5CY9YN71","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5116","S329XXA","Z79891","M84454A","L4050","M9702XD","M25552","Z96642","Z0000","M7062","L409","Z79631","E039","E8352","R7989","S82871A","I739","M79652","X58XXXA","M19271","Z23","M5450","M84454D","W19XXXD","S3402XA","N1830","M19071","M8448XA","S82891A","M25571","M84471A","L4059","N189","Z5181","I10","Z01810","S82871K","M810","I129","M9701XA","M9702XA","M19072","Z0001","S72115D","S329XXD","M21171","M8008XD","Z96643","M5489","Z743","M5136","Z833","G8929","M170"],"date":["2023-12-12","2023-12-22","2023-09-28","2023-11-24","2025-07-28","2023-09-28","2023-09-22","2023-09-22","2024-01-03","2024-02-06","2024-11-06","2025-03-12","2024-04-05","2023-03-17","2023-03-17","2024-11-01","2025-05-16","2023-09-28","2024-11-01","2024-11-01","2025-02-18","2023-10-24","2024-01-09","2024-01-09","2024-01-05","2023-12-04","2023-09-27","2023-10-29","2024-11-14","2025-10-15","2023-09-27","2025-09-05","2022-12-09","2022-12-09","2023-12-14","2023-10-12","2024-10-17","2025-08-07","2023-10-29","2024-01-09","2024-01-09","2023-03-20","2025-02-04","2023-12-01","2023-11-08","2023-09-27","2024-02-04","2023-11-24","2023-11-02","2023-11-02","2023-12-22","2023-12-22","2023-07-17","2023-07-17"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","TERIPARATIDE","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","LEUCOVORIN CALCIUM","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METHOTREXATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","OXYCONTIN","","","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":""}]}]}