{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Harold R Buckner","gend":0,"currentgend":"","add":"528 BISHOP HILL RD","city":"LEEDS","state":"ME","zip":"04263","dob":"1952-02-08","age":"","mstatus":"","insh":"10000054196","cliId":"","pno":2079333987,"cno":2072322098,"email":"halbuckner@yahoo.com","ename":"","eno":"","pphy":"KIM, REGINA Y","ppno":2075351340,"pcpadd":"MERCY WEST FALMOUTH PRIMARY CARE,75 GRAY RD","pcpcity":"FALMOUTH","pcpstate":"ME","pcpzip":"04105","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE WEST FALMOUTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"528 BISHOP HILL RD","madd2":"","madd3":"","mcity":"LEEDS","mstate":"ME","mzip":"04263","pcpfaxno":2075351358,"pcpnpi":1104906155,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3GG9EW2RA44","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I3481","I517","I509","F419","F32A","G4733","I6389","E1165","Z0000","G3184","E1159","E7800","I10","Z8673","E1151","Z794","Z7984","F1920","I739","K4090","Z7982","Z7902","I779","J309","E118","D122","D123","E11649","R6889","I5032","E785","Z125","Z1211","I5022","I6789","E119","Z0100","R4189","I429","I2510","L603","R2689","K5730","I998","I70213","I745","G4761","G4721","E663","E1129","F329","N400","G4731","R400","R0683","R0681","F331","E113293","E782","M459","I110","R399","R3915","N401","G479","F411"],"date":["2024-04-17","2024-04-17","2024-04-17","2023-08-21","2023-06-12","2025-10-01","2025-10-07","2025-11-07","2025-03-14","2025-10-28","2024-12-31","2024-12-31","2024-12-31","2025-10-28","2023-03-09","2024-06-12","2024-03-08","2024-12-04","2024-10-17","2024-10-17","2024-10-17","2024-10-17","2022-12-13","2025-09-03","2024-08-26","2024-06-05","2024-06-05","2025-03-31","2023-10-25","2024-04-17","2022-11-30","2024-03-01","2024-06-05","2024-01-09","2023-04-07","2023-09-28","2025-09-24","2023-04-07","2023-09-13","2023-09-28","2022-12-21","2023-03-06","2024-06-05","2024-10-10","2022-11-16","2022-11-16","2022-10-11","2022-10-11","2022-10-11","2022-09-12","2022-08-04","2022-05-13","2022-05-04","2022-05-04","2022-04-15","2022-04-15","2022-03-30","2022-03-18","2021-12-14","2022-01-10","2022-01-10","2022-01-25","2022-01-25","2022-01-25","2022-02-18","2022-02-23"],"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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-200","","","Select","Select",""],["","","INSULIN ASPART FLEXPEN","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-100","","","Select","Select",""],["","","MEMANTINE HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","INSULIN DEGLUDEC PEN (U-200)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","DEXCOM G6 TRANSMITTER","","","Select","Select",""],["","","DEXCOM G6 SENSOR","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","DEXCOM G7 RECEIVER","","","Select","Select",""],["","","CILOSTAZOL","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","OMNIPOD 5 DEXG7G6 INTRO(GEN 5)","","","Select","Select",""],["","","OMNIPOD 5 DEXG7G6 PODS (GEN 5)","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","FREESTYLE TEST STRIPS","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","BAQSIMI","","","Select","Select",""],["","","OMNIPOD 5 G6 INTRO KIT (GEN 5)","","","Select","Select",""],["","","OMNIPOD 5 G6 PODS (GEN 5)","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}