{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Bruce H Sturgeon","gend":0,"currentgend":"","add":"968 MAPLETON RD","city":"Mapleton","state":"ME","zip":"04757","dob":"1952-03-09","age":"","mstatus":"","insh":"10000055486","cliId":"","pno":2077643809,"cno":2072273356,"email":"declined@062025.com","ename":"","eno":"","pphy":"MACHARIA, THOMAS C","ppno":2077643142,"pcpadd":"146 ACADEMY ST,","pcpcity":"PRESQUE ISLE","pcpstate":"ME","pcpzip":"47693102","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE PRESQUE ISLE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"968 MAPLETON RD","madd2":"","madd3":"","mcity":"Mapleton","mstate":"ME","mzip":"04757","pcpfaxno":2077608170,"pcpnpi":1881853919,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5PC3CT1NM79","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R4701","J449","I209","I4891","I4720","R519","I4819","I4820","G4734","I25118","J441","J189","R0902","Z09","Z23","G4733","G459","I10","Z7901","I498","R42","Z87891","Z8709","Z7982","J329","M542","H9202","R0989","R490","J029","I495","Z9989","J440","T447X5A","I119","E785","M25561","M25562","Z48817","H5319","H25813","M2352","M2351","M170","Z0001","L853","Z4802","L821","Z08","Z85820","Z85828","D2261","H538","E6601","Z6839","R0981","Z7951","G4730","N400","Z79899","N179","L02211","R0683","H40013","Z1211","U071","K521","A419","I5033","J13","J9601","R350","D72829"],"date":["2023-10-16","2024-08-07","2023-11-29","2023-11-29","2023-11-29","2023-10-16","2023-10-16","2025-02-06","2024-05-06","2023-10-26","2025-08-13","2025-08-13","2025-08-13","2023-10-16","2025-01-06","2025-05-13","2023-10-16","2024-09-12","2024-04-24","2023-11-29","2023-10-13","2025-05-08","2024-05-16","2025-02-07","2024-04-14","2024-04-14","2024-04-24","2024-04-24","2024-04-24","2024-04-25","2023-08-20","2023-08-21","2023-08-20","2023-08-20","2024-03-07","2024-03-07","2023-07-18","2023-07-18","2023-09-21","2023-02-06","2025-02-07","2023-07-19","2023-07-19","2023-07-19","2025-02-06","2023-12-07","2023-09-21","2024-09-23","2024-09-23","2024-09-23","2024-09-23","2023-09-05","2024-02-07","2023-04-27","2023-04-27","2023-05-05","2023-02-21","2023-02-21","2025-02-06","2023-01-30","2025-02-14","2025-08-02","2022-10-21","2025-02-07","2022-09-16","2022-09-23","2022-09-23","2022-09-01","2022-09-01","2022-09-01","2022-09-01","2022-08-30","2022-09-06"],"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":[["","","XARELTO","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","CARTIA XT","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","LAGEVRIO (EUA)","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SPIRIVA RESPIMAT","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","ADVAIR DISKUS","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","DILTIAZEM 24HR ER","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","BUDESONIDE","","","Select","Select",""],["","","ELIQUIS","","","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":""}]}]}