{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jane E Carnabuci","gend":1,"currentgend":"","add":"17 LOON LN","city":"PALMYRA","state":"ME","zip":"04965","dob":"1950-11-23","age":"","mstatus":"","insh":"10000046729","cliId":"","pno":2079382050,"cno":"","email":"JCARNABU@YAHOO.COM","ename":"","eno":"","pphy":"CIANCHETTE, EMILY B","ppno":2074875154,"pcpadd":"470 SOMERSET AVE,","pcpcity":"PITTSFIELD","pcpstate":"ME","pcpzip":"49674928","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE PITTSFIELD","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 12","madd2":"","madd3":"","mcity":"PALMYRA","mstate":"ME","mzip":"04965","pcpfaxno":2074873158,"pcpnpi":1083620314,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6HJ8J44FN46","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25551","I4891","Z45018","I4819","M47814","I495","I119","E785","M9902","M546","M9905","I480","Z7901","M5450","Z0000","R0683","R0602","G4733","Z950","R0789","D45","R531","I6782","R0609","E039","I10","M47816","Z006","I4892","Z7982","Z95818","M7071","Z0100","R001","M549","R42","E041","G4730","Z01818","Z01810","R233","I4719","Z48810","H2513","H02834","H02831","H53453","Z87891","Z7902","R6889","M5116","I700","I081","I4710","Z1231","R0600","I2720","I493","I491","M4180"],"date":["2023-04-14","2025-11-04","2025-10-27","2025-08-25","2024-12-03","2023-07-29","2023-07-27","2023-07-27","2023-06-26","2023-06-26","2023-06-26","2024-04-30","2025-02-27","2024-05-08","2024-12-24","2023-08-16","2023-04-06","2025-04-28","2024-12-18","2023-04-06","2025-09-05","2023-01-13","2023-01-13","2024-04-18","2025-01-13","2025-06-12","2025-02-27","2023-07-16","2023-07-16","2025-02-27","2025-09-12","2023-05-08","2025-08-14","2024-07-30","2024-05-28","2023-01-13","2023-11-16","2024-10-03","2023-02-09","2025-03-11","2025-01-22","2025-05-05","2023-03-02","2023-03-02","2023-02-24","2023-02-24","2023-02-24","2025-01-15","2025-01-15","2023-12-15","2024-05-17","2023-06-20","2023-06-20","2024-07-30","2023-09-13","2024-04-17","2024-04-18","2024-01-23","2024-01-23","2024-11-13"],"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":[["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","SYNTHROID","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","CARTIA XT","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","KAPSPARGO SPRINKLE","","","Select","Select",""],["","","PAROXETINE HCL","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","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":""}]}]}