{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Charles H Brown","gend":0,"currentgend":"","add":"258 RIPLEY RD","city":"SAINT ALBANS","state":"ME","zip":"04971","dob":"1949-05-12","age":"","mstatus":"","insh":"10000049383","cliId":"","pno":2079382271,"cno":"","email":"","ename":"","eno":"","pphy":"DAY, BETHANY N","ppno":2073685747,"pcpadd":"Northern Light Health Center Newport Plaza,26 Main St Ste 2","pcpcity":"Newport","pcpstate":"ME","pcpzip":"04953","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HEALTH CENTER NEWPORT PLAZA","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"258 RIPLEY RD","madd2":"","madd3":"","mcity":"SAINT ALBANS","mstate":"ME","mzip":"04971","pcpfaxno":2073685483,"pcpnpi":1023361953,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1HN1HK6PG04","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0001","Z0100","Z48812","E119","I25119","I10","I2720","J449","R0902","J441","J101","J189","I2510","E0789","Z01810","Z951","L309","J90","J9811","L308","L209","Z7189","L409","R059","R109","R110","R1011","N281","Z1211","Z86010","K640","D122","R079","I130","E785","R053","R0602","J1000","D225","L821","L814","L2089","R509","I25110","J439","I6523","I119","J984","R42","F424","Z87891","Z4682","Z7982","Z8249","I454","I440","I493","I491","Z09","I509","R0600","R0789","R001","Z0000","J1001","D125","D128","R590","J0190","Z7689"],"date":["2025-07-18","2025-06-02","2025-04-21","2024-10-14","2024-08-14","2025-08-08","2023-06-02","2025-11-14","2025-11-04","2025-02-01","2025-02-01","2025-06-18","2025-03-30","2025-06-27","2025-03-20","2025-07-02","2023-03-08","2025-04-21","2025-04-21","2023-03-08","2023-03-23","2023-03-23","2022-12-07","2024-12-16","2025-03-24","2025-03-24","2025-03-24","2025-03-24","2024-01-11","2024-01-11","2024-01-11","2024-01-11","2023-05-29","2025-10-27","2023-10-30","2025-10-21","2023-05-23","2025-02-10","2024-03-27","2024-03-27","2024-03-27","2024-03-27","2024-12-16","2024-12-09","2025-05-06","2025-03-20","2025-09-30","2025-03-20","2025-03-20","2023-03-08","2025-05-06","2025-03-23","2025-01-06","2025-01-06","2023-07-17","2023-07-17","2023-07-17","2023-07-17","2025-04-03","2025-10-27","2025-10-27","2025-10-27","2023-06-06","2025-06-04","2025-02-01","2024-01-11","2024-01-11","2025-08-14","2025-01-10","2025-06-02"],"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":[["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","RANOLAZINE ER","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","LEVALBUTEROL TARTRATE HFA","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUGMENTED","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","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":""}]}]}