{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kathie A Mason","gend":1,"currentgend":"","add":"56 NORTH MAIN AVE","city":"ORONO","state":"ME","zip":"04473","dob":"1950-01-04","age":"","mstatus":"","insh":"10000056629","cliId":"","pno":5622776140,"cno":"","email":"noranick2995@gmail.com","ename":"","eno":"","pphy":"GRISSOM, AMBER N","ppno":"","pcpadd":"Northern Light Internal Medicine,302 Husson Ave Ste 1","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"56 NORTH MAIN AVE","madd2":"","madd3":"","mcity":"ORONO","mstate":"ME","mzip":"04473","pcpfaxno":2079735042,"pcpnpi":1689177867,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3T45FN5JU80","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M9913","M9912","M9911","M9917","Z01810","I6522","E785","Z79899","Z471","Z0000","I10","M9903","M5450","M9902","M9901","H9313","H905","R0981","H6121","Z96641","M160","Z1211","M25551","M94261","Z0101","M1711","L659","L729","R030","R209","R32","L259","Z713","Z1231","M1611","N6331","Z01812","M1990","L723","N6489","Z4802","M25561","T50991A","H43812","D649","R21","M778","X58XXXA","R2231","N6081","M79672","H6093","E6601","Z6841","Z87891","E039","Z5181","L02411","R040","R0989","G8929"],"date":["2025-11-03","2025-11-03","2025-11-03","2025-11-03","2023-05-23","2024-12-16","2025-01-22","2025-05-22","2023-12-18","2024-05-28","2025-06-12","2023-05-24","2023-05-24","2023-05-24","2023-05-24","2023-10-30","2023-10-30","2023-10-30","2023-10-30","2025-01-29","2023-04-04","2025-07-06","2023-05-22","2024-12-22","2025-06-23","2025-01-29","2024-10-01","2024-10-01","2023-08-26","2023-08-26","2023-08-26","2024-10-11","2022-12-20","2025-03-18","2023-06-12","2025-07-28","2023-05-23","2023-05-23","2024-10-04","2025-03-24","2024-10-22","2025-01-29","2024-07-21","2025-06-30","2023-10-12","2024-10-11","2025-04-24","2024-07-21","2025-07-28","2025-07-28","2025-05-22","2025-05-22","2023-09-28","2023-09-28","2023-06-12","2024-11-18","2024-11-18","2025-03-24","2023-08-08","2025-01-03","2022-11-22"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","NYSTOP","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y 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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}