{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ashley R Powers","gend":0,"currentgend":"","add":"70 HERRICK RD APT 6","city":"SOUTHWEST HARBOR","state":"ME","zip":"04679","dob":"1952-01-01","age":"","mstatus":"","insh":"10000059973","cliId":"","pno":2072149156,"cno":2076643301,"email":"declined@09212021.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":"PO BOX 175","madd2":"","madd3":"","mcity":"SOUTHWEST HARBOR","mstate":"ME","mzip":"04679","pcpfaxno":2072445515,"pcpnpi":1487711909,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2VA0FF7TR32","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N401","I10","G4733","E7800","F17290","D62","Z0101","H26493","H52222","I4811","R9431","Z01812","N451","R6881","Z48816","Z4682","Z954","J939","J982","Z452","J90","H26491","I350","I4891","I509","J811","R0609","I5021","R0602","R7989","R351","H35341","H5340","I110","I358","H547","J948","I4820","H35372","R0902","I3139","Z98890","J9811","H25042","N138","R39198","S0990XA","I429","R29898","R29818","G9389","I6523","E8342","E876","H26492","Z125","L570","J439","Z0000","K2270","M5126","Z1211","Z860101","I639"],"date":["2024-01-29","2023-12-18","2022-12-27","2024-04-16","2025-07-24","2025-09-04","2025-09-05","2024-11-12","2025-09-05","2025-07-20","2025-07-24","2024-01-23","2024-02-19","2025-06-11","2025-01-08","2025-08-07","2025-08-16","2025-08-16","2025-08-16","2025-08-09","2025-08-20","2023-10-12","2025-08-11","2025-07-20","2025-09-13","2025-08-18","2024-05-13","2025-07-21","2025-07-20","2025-08-16","2024-01-29","2023-09-12","2025-08-25","2025-08-16","2025-07-28","2025-08-23","2025-08-08","2025-05-27","2023-09-12","2025-08-20","2025-08-20","2025-09-10","2025-07-31","2023-10-19","2024-01-29","2024-01-29","2025-07-30","2025-07-08","2025-07-29","2025-07-29","2025-08-10","2025-08-23","2025-07-24","2025-07-24","2023-10-19","2023-04-13","2023-04-13","2025-08-07","2023-04-13","2025-06-02","2023-04-13","2025-06-02","2025-06-02","2025-08-01"],"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",""],["","","FUROSEMIDE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","BETHANECHOL CHLORIDE","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","FLUZONE QUAD 2023-2024","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","ENTRESTO","","","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":""}]}]}