{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Joanne E Hopkins","gend":1,"currentgend":"","add":"300 WASHINGTON JCTN RD","city":"HANCOCK","state":"ME","zip":"04640","dob":"1959-08-23","age":"","mstatus":"","insh":"10000060021","cliId":"","pno":2072663425,"cno":"","email":"joannejoy177@gmail.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":"300 WASHINGTON JCTN RD","madd2":"","madd3":"","mcity":"HANCOCK","mstate":"ME","mzip":"04640","pcpfaxno":2072445515,"pcpnpi":1487711909,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1TU6AV0JJ71","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H35371","Z98890","Z961","K589","L0390","F332","G4733","R42","I5030","F329","J45909","R6889","B354","Z0000","U071","J440","J1281","J441","A6920","Z4800","R0600","N189","R052","N888","S46819A","E039","R918","J0190","L02419","I509","Z1231","R87610","I10","N950","N9089","J029","I340","J449","J45901","R059","R0602","F32A","E785","J849","I5033","T148XXA","E6601","H608X3","R87810","H338","H35373","L02416","R002","R000","I77810","S41119A","R9431","J181","R300","N390","B9689","N760","J342","Z79899","I7120","H9193","J310","J0100","O24419","H43813","T8529XA","K219","J189","R030","K9041","R9439","I2510","I129","R0609","Z01818","R079","K769","K7689"],"date":["2023-05-15","2022-10-05","2022-10-05","2022-10-05","2024-10-30","2024-10-23","2024-12-27","2024-01-04","2024-12-27","2024-09-17","2024-06-28","2023-12-31","2023-01-10","2024-12-13","2024-09-12","2022-12-31","2022-12-31","2022-12-31","2023-06-01","2024-11-25","2024-04-18","2024-08-28","2023-10-30","2024-08-29","2023-12-27","2024-12-13","2024-07-05","2024-09-24","2024-11-22","2024-04-25","2024-02-26","2024-08-29","2024-09-24","2023-01-10","2023-01-10","2023-03-29","2024-12-27","2023-07-12","2023-03-29","2023-11-03","2023-11-03","2023-10-30","2023-08-08","2023-08-08","2022-10-28","2023-02-07","2023-03-21","2023-06-13","2024-08-29","2024-10-22","2024-10-22","2024-11-22","2024-01-12","2024-01-12","2024-05-07","2024-01-04","2024-01-04","2022-12-29","2024-08-09","2024-08-09","2024-08-09","2024-07-22","2024-05-22","2023-01-18","2024-05-21","2023-06-13","2023-06-13","2024-09-12","2023-03-21","2023-05-15","2023-05-15","2023-03-24","2022-12-29","2024-02-21","2022-09-28","2022-07-09","2022-07-09","2022-07-09","2022-07-13","2022-07-01","2022-06-10","2022-05-03","2022-03-31"],"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":[["","","DICYCLOMINE HCL","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","OFEV","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CLOTRIMAZOLE","","","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":""}]}]}