{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Judith E Smith","gend":1,"currentgend":"","add":"5 SOMERSET ST APT 206","city":"BREWER","state":"ME","zip":"04412","dob":"1949-04-15","age":"","mstatus":"","insh":"10000047691","cliId":"","pno":2079911007,"cno":"","email":"MOMGGG2012@GMAIL.COM","ename":"","eno":"","pphy":"FAGLES, NINA E","ppno":2079890550,"pcpadd":"84 KELLEY RD,","pcpcity":"ORONO","pcpstate":"ME","pcpzip":"44733416","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"58 COLONIAL CIR APT 222","madd2":"","madd3":"","mcity":"BREWER","mstate":"ME","mzip":"04412","pcpfaxno":"","pcpnpi":1124069851,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3JG7VK3MF60","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","E039","L814","L821","D2371","Z08","R918","E042","Z1231","Z23","Z0000","Z0101","H40013","K219","L239","E785","F32A","G5790","I2699","D6859","Z87891","M810","G629","E8770","M79671","Z0001","R6889","R2241","G6289","R197","K634","K5730","K640","Z1211","K6289","R195","E079","D225","Z85820","L570","E778","Z7189","E041","Z09","M1990","U071","Z7401","R002","D171","R0600","S52502D","S52602D","S52572D","M25532","Z98890"],"date":["2025-10-28","2025-10-28","2024-11-20","2024-11-20","2024-11-20","2024-11-20","2024-11-07","2025-02-10","2025-10-14","2025-10-02","2025-10-14","2025-05-16","2025-05-16","2025-10-28","2024-07-25","2025-03-31","2025-03-31","2023-12-11","2023-02-06","2023-01-26","2023-01-26","2024-03-27","2023-08-28","2023-08-28","2023-12-17","2024-03-27","2023-05-12","2023-12-17","2023-12-21","2023-07-27","2023-07-27","2023-07-27","2023-07-27","2023-07-27","2023-07-27","2022-12-16","2023-12-21","2023-11-21","2023-11-21","2024-05-21","2023-01-30","2023-05-09","2023-02-09","2022-11-10","2022-11-10","2022-11-06","2022-11-06","2022-11-06","2022-11-22","2022-11-05","2022-07-08","2022-07-08","2022-07-08","2022-07-05","2022-07-08"],"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",""],["","","LISINOPRIL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","CHOLESTYRAMINE","","","Select","Select",""],["","","PREVALITE","","","Select","Select",""],["","","ENOXAPARIN SODIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","PREVNAR 20","","","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":""}]}]}