{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marilyn B Whipple","gend":1,"currentgend":"","add":"34 MIDDLE ROAD","city":"CUMBERLAND CENTER","state":"ME","zip":"04021","dob":"1942-09-29","age":"","mstatus":"","insh":"10000059307","cliId":"","pno":2076710141,"cno":"","email":"bike629@aol.com","ename":"","eno":"","pphy":"KAZIMIERCZAK, ADAM M","ppno":2075351340,"pcpadd":"75 GRAY RD,","pcpcity":"FALMOUTH","pcpstate":"ME","pcpzip":"41052010","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":"34 MIDDLE RD","madd2":"","madd3":"","mcity":"CUMBERLAND CENTER","mstate":"ME","mzip":"04021","pcpfaxno":2075351358,"pcpnpi":1467459032,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5TG3T18NP95","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M9902","M9900","M9905","M9907","A6920","H409","M79646","S63619A","N3941","R601","Z1231","M9904","R519","R208","N39492","M25569","H5310","M9901","M9908","M9906","R600","M542","M25562","H401122","M5459","H6121","H25812","H25811","R6889","L821","L570","D0430","D485","L578","L814","Z0000","D0439","M8580","M65341","H401111","M79621","M9909","M79639","W06XXXA","D492","R279","D373","C44319","H10213","M85852","M810","E559","E7211","I10"],"date":["2025-10-06","2025-10-06","2025-10-06","2025-06-23","2022-12-30","2024-08-07","2023-06-07","2023-06-07","2023-10-02","2023-05-09","2024-07-16","2023-04-11","2023-08-08","2023-04-11","2023-02-13","2023-02-13","2023-01-12","2025-05-27","2025-10-06","2023-10-02","2023-07-12","2023-08-08","2024-08-07","2025-09-09","2023-06-07","2024-12-12","2024-02-28","2024-02-28","2023-11-01","2024-02-22","2024-04-24","2023-12-07","2024-02-22","2024-02-22","2024-02-22","2024-12-06","2023-12-14","2023-12-14","2023-08-08","2024-01-03","2023-03-14","2025-04-28","2023-09-08","2023-09-08","2025-02-18","2023-10-02","2024-08-20","2025-04-03","2022-12-13","2022-10-24","2022-10-24","2022-07-20","2022-08-02","2022-08-02"],"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":[["","","TIMOLOL MALEATE","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","DORZOLAMIDE-TIMOLOL","","","Select","Select",""],["","","OFLOXACIN","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","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":""}]}]}