{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Bonita B Poitras","gend":1,"currentgend":"","add":"25 TIDAL RETREAT WAY","city":"DEER ISLE","state":"ME","zip":"04627","dob":"1943-03-12","age":"","mstatus":"","insh":"10000053699","cliId":"","pno":2073482631,"cno":"","email":"abpoitras25@gmail.com","ename":"","eno":"","pphy":"RENSENBRINK, KATHRYN","ppno":2076647780,"pcpadd":"Northern Light Primary Care Ellsworth,32 Resort Way","pcpcity":"Ellsworth","pcpstate":"ME","pcpzip":"04605","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"25 TIDAL RETREAT WAY","madd2":"","madd3":"","mcity":"DEER ISLE","mstate":"ME","mzip":"04627","pcpfaxno":2076647721,"pcpnpi":1124067194,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5Y88J27DJ44","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C44329","R5383","M1711","K219","L570","R002","D485","D0439","E7800","F339","R0989","M179","R6889","J370","H903","G501","Z0101","H04123","L578","L821","L905","N390","M7989","H52223","H6990","N281","M160","M5136","M47816","M4316","M5459","M546","R490","N200","Z98890","M47817","M79673","M722","R32","N3946","Z87442","I10","E6601","Z0000"],"date":["2024-07-08","2025-07-28","2025-07-28","2025-07-07","2025-04-10","2025-09-01","2024-03-29","2024-05-09","2023-09-18","2025-08-21","2023-09-18","2023-09-18","2023-05-03","2025-02-24","2025-07-31","2025-02-24","2025-04-25","2023-04-06","2025-04-10","2025-04-10","2025-04-10","2024-10-22","2025-07-28","2025-04-25","2024-10-30","2023-01-06","2024-07-01","2024-07-01","2024-07-01","2024-07-01","2024-07-01","2023-06-12","2025-02-24","2023-03-09","2023-03-09","2023-06-12","2025-01-09","2025-01-09","2025-01-09","2025-06-05","2025-06-05","2023-05-30","2023-05-30","2023-05-30"],"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":[["","","SERTRALINE HCL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","ESOMEPRAZOLE MAGNESIUM","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","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":""}]}]}