{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Christine E Cuneo","gend":1,"currentgend":"","add":"29 RAVENSWOOD LN","city":"BLUE HILL","state":"ME","zip":"04614","dob":"1953-02-15","age":"","mstatus":"","insh":"10000059917","cliId":"","pno":2076678036,"cno":"","email":"cuneo.ce@gmail.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":"130 OAK ST STE 7","madd2":"","madd3":"","mcity":"ELLSWORTH","mstate":"ME","mzip":"04605","pcpfaxno":2076647721,"pcpnpi":1104447820,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6RM0N91CV14","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25552","M6281","R2681","R269","M9902","M546","E785","I119","M48062","M5136","M47816","M5137","I10","G4733","G4736","M9904","M461","M9903","M5417","M4316","M4726","R6889","Z1231","M5459","M419","M542","M4802","Z0000","R7309","M48061","M5116","I350","M5416","R1011","M4807","M5450","M79605","R609","K589","M7062","Z87891","M1612","L814","N810","D225","L821","Z7189","R399","Z860100","Z0100","D485","L2089","M5127","M47817","D1801","D692","L304"],"date":["2024-10-28","2024-10-28","2024-10-28","2024-10-28","2025-09-17","2025-09-17","2024-11-14","2025-01-03","2023-04-25","2023-12-07","2023-12-14","2023-12-07","2025-07-28","2025-03-20","2025-01-13","2023-06-08","2023-06-08","2025-09-17","2023-06-08","2024-04-27","2024-04-27","2023-02-18","2024-07-29","2025-09-17","2025-07-17","2025-07-17","2025-07-17","2025-05-29","2024-05-16","2024-04-27","2024-04-27","2025-07-28","2024-06-13","2023-09-18","2023-04-25","2023-01-02","2023-11-30","2024-06-10","2023-09-18","2024-08-29","2024-08-29","2024-08-29","2024-10-10","2023-01-26","2024-10-10","2024-10-10","2024-10-10","2025-06-02","2025-07-28","2024-07-01","2023-08-14","2023-08-14","2022-09-30","2022-09-30","2022-08-22","2022-08-22","2022-08-22"],"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":[["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","REPATHA SURECLICK","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","DOXAZOSIN MESYLATE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","BETAMETHASONE DIPROP AUGMENTED","","","Select","Select",""],["","","FLUOCINONIDE","","","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":""}]}]}