{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Polly A Mccready","gend":1,"currentgend":"","add":"1220 US HWY 1","city":"MONTICELLO","state":"ME","zip":"04760","dob":"1951-12-19","age":"","mstatus":"","insh":"10000050938","cliId":"","pno":2075381775,"cno":"","email":"DECLINED@12262024.COM","ename":"","eno":"","pphy":"DASHTI, BEHNOOSH","ppno":2077696636,"pcpadd":"140 ACADEMY ST,","pcpcity":"PRESQUE ISLE","pcpstate":"ME","pcpzip":"47693102","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE PRESQUE ISLE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 232","madd2":"","madd3":"","mcity":"MONTICELLO","mstate":"ME","mzip":"04760","pcpfaxno":"","pcpnpi":1326751223,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7ET4FF5HC83","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K5792","F419","K317","L03115","R0781","N2889","M79642","M7630","L821","R6884","R109","Z87891","M7632","M7062","Y999","H04123","H43813","H2513","M26629","K5732","Z780","R531","C641","E785","Z0101","C649","M25571","K529","F4320","I803","R053","Z7901","K2270","K219","K449","H5319","H35372","G43B0","S0990XA","R1011","K760","M79652","Z98890","I80252","M25532","M79632","M6281","Z79899","L905","Q828","Z85828","R197","F4323","R29898","Z0000","I8002","R519","F4322","R1030","K2100","K319","R195","Z1231","R140","M9900","M9901","M26603","M79671","Z09","J069","R1084","K921","S0501XA","B370","L570","S069X0A","Z85528","I8001","I288","I809","G4700","B351","F429","M8589","R634","M19042","N760","G8918","Z8616","Z23","Z872","R059","U071","H538","M79662","M25472","M7989","T50905A","T368X5A"],"date":["2025-08-06","2024-10-22","2023-12-27","2025-07-02","2025-08-06","2025-07-30","2024-07-24","2024-11-13","2023-02-21","2023-10-12","2025-08-06","2025-08-06","2024-09-09","2024-09-09","2024-09-09","2024-09-18","2024-09-18","2024-09-18","2024-01-19","2025-06-14","2024-04-30","2024-10-22","2025-07-30","2024-02-20","2025-01-13","2025-08-05","2023-12-08","2025-06-23","2024-10-10","2025-07-15","2025-07-28","2025-07-15","2023-12-26","2024-01-16","2025-02-06","2023-04-19","2023-04-25","2023-04-25","2023-03-28","2025-01-02","2025-01-02","2023-09-27","2024-12-17","2025-06-27","2024-04-01","2024-04-01","2024-04-01","2025-03-27","2023-02-21","2023-02-21","2023-02-21","2025-05-30","2025-03-27","2023-09-18","2024-05-07","2025-07-17","2023-04-19","2025-06-15","2024-10-04","2023-12-27","2023-12-27","2025-05-22","2023-07-20","2024-10-04","2023-11-03","2023-11-03","2023-11-03","2023-12-12","2025-06-23","2023-02-08","2025-08-06","2025-05-24","2022-11-03","2024-10-03","2025-02-24","2023-04-04","2024-12-30","2025-06-27","2025-02-06","2024-11-22","2023-09-18","2023-05-30","2023-12-01","2024-03-08","2025-05-29","2024-04-01","2025-07-02","2025-08-06","2022-11-28","2022-11-28","2025-07-08","2022-09-14","2022-08-16","2022-06-20","2022-06-23","2022-06-22","2022-06-22","2022-06-16","2022-06-16"],"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":[["","","OXYCODONE HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","LEVOFLOXACIN","","","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":""}]}]}