{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Wayne E Fitch","gend":0,"currentgend":"","add":"68 CASTLE ISLAND RD","city":"BELGRADE","state":"ME","zip":"04917","dob":"1943-01-25","age":"","mstatus":"","insh":"10000046186","cliId":"","pno":2073133954,"cno":"","email":"declined@082523.com","ename":"","eno":"","pphy":"DOUGLAS, JAMES W","ppno":"","pcpadd":"10 WASHINGTON ST,","pcpcity":"WATERVILLE","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE CLINTON","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2076020915,"add2":"","add3":"","madd1":"68 CASTLE ISLAND RD","madd2":"","madd3":"","mcity":"BELGRADE","mstate":"ME","mzip":"04917","pcpfaxno":"","pcpnpi":1760467187,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3HU4VN0AK62","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M542","E1169","L282","J029","M79604","M79605","R0989","Z950","J101","T375X5A","R519","Z23","M25559","M9900","M9901","M9902","M9909","R109","B351","N1832","I4430","S0990XA","G319","S2241XA","I7140","J9811","S199XXA","J939","M47812","M5030","K5730","I499","R051","R918","Z4682","I441","R0600","E221","R058","D649","R42","R195","R079","Z452","S299XXA","R937","R0781","I129","Z45018","M79662","Z0101","E559","S270XXD","S2241XD","S36113D","W001XXD","W19XXXD","R809","I2510","M47814","J069","Z955","I10","M549","W19XXXA","N401","M25512","E1165","M2550","G4733","M5450","Z0000","R1013","R350","R5383","K5900","S272XXA","S36113A","N179","I252","N644","S36114A","I440","R001","I739","R6884","Z87891","S22009A","Z7982","R748","R7989","R1310","G44209","M7661","S86011D","X58XXXD","S86011A","R600","M7989","M25571","S86911A"],"date":["2025-10-02","2025-10-27","2023-05-31","2025-09-11","2024-06-18","2024-06-18","2024-06-18","2024-07-23","2024-02-18","2024-02-18","2025-02-13","2025-10-23","2025-10-30","2025-10-30","2025-10-30","2025-10-30","2025-10-30","2024-04-19","2024-07-08","2024-03-13","2025-09-25","2022-12-21","2022-12-21","2024-02-18","2022-12-21","2022-12-26","2022-12-21","2022-12-21","2022-12-21","2022-12-21","2022-12-21","2023-01-04","2025-06-02","2022-12-22","2022-12-26","2025-04-07","2022-12-21","2023-06-20","2024-02-18","2023-02-08","2023-07-28","2025-04-17","2022-12-24","2022-12-22","2022-12-22","2022-12-22","2025-05-01","2024-03-13","2024-01-26","2024-02-01","2024-01-08","2025-03-12","2023-01-12","2023-01-12","2023-01-04","2023-01-04","2023-01-12","2023-03-22","2024-03-13","2024-04-19","2025-09-11","2023-05-16","2024-08-15","2025-04-03","2022-12-21","2024-03-13","2025-01-23","2024-04-08","2025-06-06","2023-11-28","2024-05-09","2024-12-03","2023-11-28","2024-10-01","2023-11-28","2024-10-01","2022-12-27","2022-12-27","2022-12-27","2024-12-03","2023-05-19","2022-12-22","2022-12-22","2022-12-28","2024-12-03","2025-03-06","2023-01-12","2023-01-12","2024-07-23","2023-05-31","2023-06-20","2023-01-03","2024-12-19","2022-09-07","2022-07-13","2022-07-13","2022-07-06","2022-07-06","2022-07-06","2022-06-16","2022-06-16"],"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":[["","","NYSTATIN","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","CILOSTAZOL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","TAMSULOSIN 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":[]}},{"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":""}]}]}