{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rose Robichaud","gend":1,"currentgend":"","add":"47 GETCHELL ROAD","city":"EDDINGTON","state":"ME","zip":"04428","dob":"1949-01-30","age":"","mstatus":"","insh":"10000047367","cliId":"","pno":2078436007,"cno":"","email":"rose.robichaud@gmail.com","ename":"","eno":"","pphy":"KNIPSCHER, KATHLEEN A","ppno":2079890550,"pcpadd":"Eastern Maine Medical Center,43 Whiting Hill Rd","pcpcity":"Brewer","pcpstate":"ME","pcpzip":"04412","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"47 GETCHELL ROAD","madd2":"","madd3":"","mcity":"EDDINGTON","mstate":"ME","mzip":"04428","pcpfaxno":2079890551,"pcpnpi":1376071894,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9M88GY3XK35","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1611","M25551","M6281","R262","Z96642","Z471","Z96641","M7062","M1612","Z87891","H02402","D225","L821","L814","Z7189","Z01818","D3611","Z1231","M160","H02834","H02831","H04123","E785","R002","Z01810","R5383","Z130","R399","J449","Z23","Z0000","E039","R739","D509","K2289","E668","Z6836","Z0100","F331","Z79899","K219","D485","R1310","R300","M25552","D649","R61","G8929","G2581","I498","I491","I4720","Z0101","H52223","H02839","H43811","H903","M7910","J441","M7072","L820","R208","D2372","L905","L570","R053","L819","R0602","L989","R0982","M4802","M48061"],"date":["2023-06-21","2023-09-07","2023-09-07","2023-09-07","2023-09-07","2024-06-19","2024-06-19","2025-07-25","2025-07-25","2025-07-25","2025-05-01","2024-11-27","2024-11-27","2024-11-27","2024-11-27","2023-03-16","2023-11-03","2024-06-19","2022-12-29","2025-04-28","2025-04-28","2024-04-05","2025-06-05","2025-01-06","2023-05-24","2024-08-27","2023-03-16","2022-12-29","2025-06-04","2025-02-24","2025-02-24","2024-12-18","2024-02-09","2024-02-09","2024-09-13","2023-03-01","2023-03-01","2022-11-29","2025-03-31","2025-03-31","2024-04-10","2023-11-03","2024-09-13","2023-02-01","2025-08-27","2023-07-25","2023-07-25","2023-04-14","2024-12-23","2025-02-05","2025-02-05","2025-02-05","2025-04-16","2025-04-16","2025-04-16","2025-04-16","2022-12-08","2025-10-21","2024-12-26","2022-10-25","2022-10-28","2022-10-28","2022-10-28","2022-10-28","2022-10-28","2022-10-17","2022-10-20","2022-10-17","2022-09-06","2022-09-06","2022-07-19","2022-07-19"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ARNUITY ELLIPTA","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","FLOVENT HFA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DICLOFENAC 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":""}]}]}