{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Naomi F Hawes","gend":1,"currentgend":"","add":"419 HAMPDEN RD","city":"CARMEL","state":"ME","zip":"04419","dob":"1951-12-13","age":"","mstatus":"","insh":"10000051830","cliId":"","pno":2077453478,"cno":"","email":"grammamnh@gmail.com","ename":"","eno":"","pphy":"TOULOUSE, TIFFANY R","ppno":2074875154,"pcpadd":"SVH Family Care,470 Somerset Ave","pcpcity":"Pittsfield","pcpstate":"ME","pcpzip":"04967","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE NEWPORT","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 59","madd2":"","madd3":"","mcity":"CARMEL","mstate":"ME","mzip":"04419","pcpfaxno":74873158,"pcpnpi":1932677416,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4XX7A52VC57","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M65341","R634","Z45018","K921","I6523","R0989","I10","E785","D649","J441","I671","D500","I25119","I6522","R079","I1310","I2510","R0789","I517","Z950","Z951","M160","I6521","M810","K922","H26493","H43813","F17210","D509","Z122","H3582","H26491","Z1231","Z0001","Z0000","I25118","J449","K254","I252","I480","F331","Z0100","H26492","R6889","H5712","H2512","H2511"],"date":["2024-02-23","2025-10-27","2025-11-04","2024-04-01","2025-08-08","2023-01-04","2025-10-17","2023-06-21","2024-05-14","2025-01-08","2023-04-18","2024-06-19","2024-08-29","2025-07-16","2025-09-21","2024-08-29","2025-01-15","2025-09-21","2023-08-28","2023-08-28","2023-08-28","2024-08-29","2023-04-18","2025-03-31","2024-02-15","2023-12-04","2023-12-04","2025-01-15","2025-09-16","2025-05-30","2024-09-03","2024-03-28","2025-03-26","2025-03-11","2024-02-12","2023-11-09","2025-01-15","2024-02-15","2023-11-10","2023-11-10","2024-05-20","2023-10-03","2024-04-04","2022-08-23","2022-07-18","2022-07-12","2022-07-07"],"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":[["","","TRAZODONE HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","NIFEDIPINE ER","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)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":""}]}]}