{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Laura L Raymond","gend":1,"currentgend":"","add":"25 TWEEDIE LN APT 75","city":"Ellsworth","state":"ME","zip":"04605","dob":"1952-12-02","age":"","mstatus":"","insh":"10000058940","cliId":"","pno":2074792280,"cno":"","email":"LAURINDAROY@YAHOO.COM","ename":"","eno":"","pphy":"BAXTER, CLARKE W","ppno":2072445513,"pcpadd":"4760 RED BANK RD STE 104,","pcpcity":"CINCINNATI","pcpstate":"OH","pcpzip":"45227154","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"25 TWEEDIE LN APT 75","madd2":"","madd3":"","mcity":"Ellsworth","mstate":"ME","mzip":"04605","pcpfaxno":2072445515,"pcpnpi":1487711909,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5TP5KC2PH56","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H2512","S52501A","F419","M5450","I10","I4891","I4892","R7989","M5126","S52571A","S52511A","K648","H527","H40013","H04123","H11442","G4733","S52501D","M47816","I4819","K649","Z7901","Z8719","M6281","Z79899","H903","H7402","Z822","I480","I484","I441","Z5181","Z0130","M25531","M51369","R7309","H2511","R6889","K625","D7589","R5383","S52511D","D509","Z1231","S62109A","M85851","M85852","Z1211","M4316","J449","K529","Z87891","Z86010","H2513","I499","Z13820","H26491","H0012","Z961","Z460","S5291XA","X58XXXA","S63094A","W010XXA","H26492","I081","I2720","H43813","M51360","M25561","M1711","M1712","M170","L659"],"date":["2023-03-20","2025-03-05","2024-08-12","2025-03-12","2025-02-20","2025-06-17","2023-05-08","2023-08-07","2025-07-03","2025-02-06","2025-02-06","2025-02-06","2023-08-04","2025-06-12","2025-06-12","2023-05-02","2025-07-23","2025-05-07","2025-08-01","2024-01-03","2024-09-18","2024-09-18","2024-09-18","2025-02-17","2024-05-13","2023-09-20","2023-09-20","2023-09-20","2025-01-28","2023-01-23","2023-01-23","2025-04-16","2025-05-09","2025-01-29","2025-05-16","2024-05-13","2023-03-06","2023-09-22","2024-02-08","2024-02-15","2024-02-15","2025-03-05","2023-11-13","2024-08-14","2025-02-06","2023-06-23","2023-06-23","2024-02-28","2024-11-12","2023-08-07","2023-08-07","2024-08-08","2024-02-08","2022-12-21","2025-06-17","2023-06-23","2024-04-19","2025-06-12","2025-06-12","2025-03-13","2025-03-05","2025-03-05","2025-02-06","2025-02-06","2024-05-02","2023-04-10","2023-04-10","2025-04-23","2024-11-12","2022-09-28","2022-09-28","2022-09-28","2022-09-28","2022-08-04"],"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":[["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","FLOVENT HFA","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","DOFETILIDE","","","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":""}]}]}