{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Irene W Mccallister","gend":1,"currentgend":"","add":"109 LOON DRIVE","city":"SULLIVAN","state":"ME","zip":"04664","dob":"1945-02-16","age":"","mstatus":"","insh":"10000051743","cliId":"","pno":2076690080,"cno":"","email":"bobandirene@live.com","ename":"","eno":"","pphy":"CROWLEY, KERRY W","ppno":2079634066,"pcpadd":"50 UNION ST,ELEANOR WIDENER DIXON MEMORIAL CLINIC","pcpcity":"ELLSWORTH","pcpstate":"ME","pcpzip":"46051586","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE GOULDSBORO","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"109 LOON DRIVE","madd2":"","madd3":"","mcity":"SULLIVAN","mstate":"ME","mzip":"04664","pcpfaxno":2079637723,"pcpnpi":1679511075,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4PR1KF3FC23","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N644","G5602","M6588","Z87891","R519","Q0700","F17210","I350","Z48812","S99921A","J8410","G5600","S1086XA","W57XXXA","I10","M069","I2510","M25561","I352","J951","R578","D62","R609","R1110","I4891","Z952","R079","R600","I77810","I214","I060","I25118","I6523","I25119","I129","N1830","E785","Z23","K219","K319","R1013","Z98890","S62327A","M5432","R197","J90","N6489","Z0000","L578","L821","D1801","L570","R918","H04123","H26493","Z4789","I6782","S62308A","M19071","G5603","J40","J329","I680","Z4682","M8580","I340","I517","Z953","C189","Z951","Z7982","M25571","J984","I351","S62307P","Z1231","I519","Y999","L820","J209","R2681","S62327D","W230XXD","S62337A","M1812","I080","M4802","M47812","M4312","S0990XA","G252","R2689","N6341","I2720","R0982","S61210A","W260XXA","N189","J9811","K3189","K2100","R479","M205X9","M19079","B351","H26491","I209","M25562","Z780","S62307A","Y998","J069","R1909","Z01810","R7301","R413","M1711","I358","R635","Z6830","J00","R011","M4317","S62307D","I6521","M8589","R928","N6325","R0789","E039","R195","M546","J986","K6389","M9901","M9907","M9902","M9908","K2970","K2980","R1010","R5383"],"date":["2025-01-24","2025-05-08","2025-02-24","2025-02-24","2025-07-21","2025-03-18","2024-07-14","2023-10-25","2023-08-22","2025-04-14","2023-06-26","2025-03-06","2025-06-12","2025-06-12","2023-08-03","2023-03-28","2024-12-16","2025-08-19","2023-07-14","2023-07-14","2023-07-14","2023-07-14","2023-07-31","2023-07-31","2023-07-31","2025-09-05","2024-12-16","2023-06-26","2023-06-20","2023-06-27","2023-06-27","2024-05-30","2023-06-27","2023-11-02","2024-05-30","2024-05-30","2024-05-30","2022-11-08","2022-12-09","2022-12-09","2022-12-09","2023-06-21","2023-10-26","2025-07-21","2025-07-21","2023-08-22","2025-07-07","2024-04-16","2024-01-29","2024-01-29","2024-01-29","2024-01-31","2024-04-22","2025-03-27","2025-03-27","2025-03-12","2024-09-30","2023-12-12","2025-04-23","2024-06-20","2024-10-11","2024-10-11","2024-10-11","2023-07-13","2025-04-14","2025-01-17","2025-01-17","2025-01-17","2024-04-22","2025-09-05","2023-08-22","2025-04-23","2024-12-16","2022-10-06","2023-12-12","2023-09-27","2025-06-10","2025-04-14","2025-01-30","2025-06-05","2025-03-18","2023-12-12","2023-12-12","2023-11-06","2023-11-06","2025-09-02","2025-02-03","2025-02-03","2025-02-03","2025-06-10","2024-01-31","2025-03-07","2025-07-07","2023-06-20","2025-06-05","2024-10-03","2024-10-03","2023-10-25","2023-07-18","2022-12-09","2022-12-09","2023-07-11","2025-07-09","2025-07-09","2025-07-09","2025-04-03","2025-09-05","2025-09-05","2025-01-08","2023-10-26","2023-10-26","2024-10-11","2023-06-22","2023-06-26","2024-08-15","2024-08-13","2025-07-21","2023-07-10","2023-04-19","2023-04-19","2023-04-19","2023-06-21","2025-07-21","2023-10-27","2023-06-30","2025-01-08","2022-09-26","2022-09-26","2022-08-16","2022-08-11","2022-08-31","2022-08-02","2022-07-28","2022-07-28","2022-08-02","2022-08-02","2022-08-02","2022-08-02","2022-08-04","2022-08-04","2022-07-28","2022-06-17"],"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",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","GAVILYTE-N","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","ONDANSETRON ODT","","","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":""}]}]}