{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Darlene A Bearse","gend":1,"currentgend":"","add":"21 EDGEWOOD WAY APT. 6","city":"Ellsworth","state":"ME","zip":"04605","dob":"1952-07-07","age":"","mstatus":"","insh":"10000059725","cliId":"","pno":2076695220,"cno":"","email":"pastordarlene@yahoo.com","ename":"","eno":"","pphy":"HOWE, KARYN","ppno":2076647780,"pcpadd":"Ellsworth Internal Medicine,32 Resort Way","pcpcity":"Ellsworth","pcpstate":"ME","pcpzip":"04605","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BLUE HILL","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"21 EDGEWOOD WAY APT. 6","madd2":"","madd3":"","mcity":"ELLSWORTH","mstate":"ME","mzip":"04605","pcpfaxno":2076647721,"pcpnpi":1104447820,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8KU3N57JK72","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H814","R42","E039","R7982","R1310","R1032","R221","R1012","R1013","M4802","Z905","Z1231","M5010","M2550","I10","G4733","K2970","R399","K5730","E669","L821","M7989","M79605","M79604","R600","R1902","M316","R519","R700","R251","H04123","K2090","K317","R9402","M797","Z7952","B070","H1132","Z0000","K2100","K3189","S8002XA","Z713","M25562","R109","Z1321","N390","M26623","M542","M546","R194","G4730","Z6841","K769","Z13820","D649","I708","R5383","R053","R413","R29898","M25519","G20A1","M25811","M19011","H538","H9203","H903","H5713","Z1211","Z780","M5030","R1011","Z13220","M25511","M25561","E66813","M47812","E6601"],"date":["2025-01-06","2025-01-06","2024-07-23","2023-10-17","2025-08-01","2025-01-21","2024-07-23","2023-09-07","2023-07-05","2025-02-08","2025-01-06","2025-02-10","2025-02-08","2023-09-26","2024-11-13","2025-06-18","2025-02-18","2025-08-07","2025-01-06","2025-04-23","2023-06-13","2024-11-27","2024-11-27","2024-11-27","2024-11-27","2025-05-12","2025-01-13","2025-02-04","2024-10-24","2024-06-05","2024-11-26","2023-09-07","2023-09-07","2024-06-05","2024-09-09","2025-02-04","2025-02-12","2023-01-03","2025-01-27","2025-02-18","2025-02-18","2023-08-15","2025-04-09","2023-08-15","2024-12-27","2023-11-16","2024-04-26","2023-12-04","2022-12-05","2024-12-13","2023-04-20","2024-09-18","2023-12-29","2025-05-12","2024-01-22","2024-12-03","2024-01-23","2024-02-14","2024-02-09","2023-11-29","2023-11-29","2025-06-24","2024-12-20","2025-06-24","2025-06-24","2023-11-29","2022-12-05","2022-12-05","2024-02-16","2023-05-25","2024-01-22","2024-12-13","2023-04-11","2025-06-16","2025-06-24","2025-01-03","2025-06-17","2024-12-13","2022-07-13"],"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":[["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","SOD SULF-POTASS SULF-MAG SULF","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","INDOMETHACIN","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","CEPHALEXIN","","","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":""}]}]}