{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Bonnie R Church","gend":1,"currentgend":"","add":"28 NECK RD","city":"WATERVILLE","state":"ME","zip":"04901","dob":"1956-11-29","age":"","mstatus":"","insh":"10000059074","cliId":"","pno":2073140456,"cno":"","email":"decline@070325.com","ename":"","eno":"","pphy":"ROY, ALISSA M","ppno":"","pcpadd":"Northern Light Health Center Unity,80 Main St","pcpcity":"Unity","pcpstate":"ME","pcpzip":"04988","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HEALTH CENTER UNITY","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"28 NECK RD","madd2":"","madd3":"","mcity":"WATERVILLE","mstate":"ME","mzip":"04901","pcpfaxno":2078731186,"pcpnpi":1912208737,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7U64XF4RR98","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","J449","Z122","G8929","M542","M79601","M5450","H109","I10","M1711","M19011","R0781","Z87891","K635","K5730","G894","M25511","M25561","M25562","M1712","R197","Z79891","Z1231","M1990","R1310","K449","H00025","Z9989","E669","Z6842","E039","E785","Z9981","Z0000","E66813","R194","Z23","R911","G4730","E6601","D649","N6452","Z79899","M549","L409","R0789","R222","H6122","G4710","R0683","R2242","Z7982","M7989","M25512","Z0001"],"date":["2025-10-08","2025-11-12","2025-07-10","2024-07-25","2024-01-18","2024-01-18","2024-07-25","2024-04-06","2024-04-12","2025-04-04","2025-04-04","2025-04-04","2025-07-14","2024-12-13","2024-12-13","2024-06-06","2024-05-09","2024-07-25","2023-09-22","2023-10-16","2024-02-28","2024-04-09","2023-11-21","2024-07-25","2023-02-21","2023-02-21","2024-04-06","2024-08-27","2023-10-30","2023-10-30","2023-02-02","2023-02-02","2024-08-06","2025-03-18","2025-09-24","2024-12-13","2025-02-04","2025-07-14","2023-05-01","2023-06-12","2024-10-25","2023-09-22","2023-09-22","2022-11-04","2022-11-04","2022-11-05","2022-11-05","2022-11-14","2022-09-12","2022-09-12","2022-08-16","2022-09-07","2022-08-16","2022-08-04","2022-07-29"],"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":[["","","MORPHINE SULFATE","","","Select","Select",""],["","","MORPHINE SULFATE ER","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","ROPINIROLE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUARIX TRIVALENT 2024-2025","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}