{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Martha A Hubbard","gend":1,"currentgend":"","add":"51 POND ROAD","city":"BURNHAM","state":"ME","zip":"04922","dob":"1951-08-16","age":"","mstatus":"","insh":"10000052141","cliId":"","pno":2079488880,"cno":"","email":"declined@081823.com","ename":"","eno":"","pphy":"KRIEGEL, CHARLES B","ppno":"","pcpadd":"Sebasticook Valley Health,80 Main St","pcpcity":"Unity","pcpstate":"ME","pcpzip":"04988","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HEALTH CENTER UNITY","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 8","madd2":"","madd3":"","mcity":"BURNHAM","mstate":"ME","mzip":"04922","pcpfaxno":2078613281,"pcpnpi":1497800734,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9W38DV2JR25","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R1084","E041","G459","Z0101","R110","R519","R42","R748","Z0001","K4090","M25552","K4030","R6889","E042","Z0000","D1809","Z48815","Z09","D110","S63502A","S60212A","M25532","W010XXA","H02233","M19032","M1812"],"date":["2024-03-03","2023-09-08","2023-10-10","2023-09-01","2023-07-25","2023-08-16","2023-08-16","2024-04-24","2025-09-05","2025-04-02","2025-06-17","2024-03-03","2023-09-01","2025-09-30","2025-09-07","2025-04-02","2024-03-27","2024-03-20","2023-03-09","2022-09-02","2022-09-02","2022-09-02","2022-09-02","2022-08-19","2022-09-02","2022-09-02"],"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":[["","","PREDNISONE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","DEXAMETHASONE","","","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":""}]}]}