{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sandra L Desjardins","gend":1,"currentgend":"","add":"116 WINTERGREEN CT","city":"Hampden","state":"ME","zip":"04444","dob":"1942-02-07","age":"","mstatus":"","insh":"10000049480","cliId":"","pno":2078622328,"cno":"","email":"sdesjardins69@gmail.com","ename":"","eno":"","pphy":"MYERS, MOLLIE R","ppno":2079737979,"pcpadd":"Northern Light Primary Care Hampden,7 Main Rd N","pcpcity":"Hampden","pcpstate":"ME","pcpzip":"04444","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE HAMPDEN","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"116 WINTERGREEN CT","madd2":"","madd3":"","mcity":"Hampden","mstate":"ME","mzip":"04444","pcpfaxno":2079737579,"pcpnpi":1154944312,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6X66E93EX43","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R3129","N200","M76821","M79631","I872","M8589","M19071","I8393","M7989","I8002","Z20822","C50919","M51360","M47816","C50412","Z170","Z79811","R9230","I82811","Z1231","H5202","H52223","H524","H26492","H43813","Z0101","Z961","R319","N281","M7731","F330","C50912","L03114","H6123","Z0130","Z1721","Z1732","Z87442","M9902","M9903","M9904","M9906","Z923","I10","Z800","I83893","Z13820","Z0001","I071","M79606","M79661","M79605","Z0000","Z780","M25471","M25472","M79671"],"date":["2024-10-04","2024-09-25","2023-05-08","2024-06-18","2024-02-02","2024-11-18","2023-03-09","2023-10-03","2024-12-11","2023-10-03","2023-01-04","2024-11-18","2025-06-20","2025-06-20","2023-10-06","2025-07-25","2024-07-31","2023-10-06","2023-09-08","2024-09-20","2023-09-21","2023-09-21","2023-09-21","2024-09-26","2024-09-26","2024-09-26","2024-09-26","2023-09-22","2024-09-16","2023-05-03","2023-08-23","2025-07-25","2025-04-22","2023-01-13","2025-02-10","2025-07-25","2025-07-25","2024-10-04","2025-07-29","2025-07-29","2025-07-29","2025-07-29","2024-07-31","2024-04-02","2023-12-29","2023-12-19","2022-11-10","2025-04-28","2022-11-10","2023-08-23","2023-08-23","2024-01-02","2024-03-28","2023-11-13","2022-09-09","2022-09-09","2022-09-09"],"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":[["","","CEPHALEXIN","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","EXEMESTANE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","NORTRIPTYLINE 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":[]}},{"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":""}]}]}