{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert J Fogler","gend":0,"currentgend":"","add":"219 FOGLER RD","city":"EXETER","state":"ME","zip":"04435","dob":"1953-03-27","age":"","mstatus":"","insh":"10000060561","cliId":"","pno":2073792428,"cno":"","email":"mfogler76@gmail.com","ename":"","eno":"","pphy":"KIRKPATRICK, LARA M","ppno":2078629400,"pcpadd":"Northern Light Primary Care Hampden,7 Main Rd N","pcpcity":"Hampden","pcpstate":"ME","pcpzip":"04444","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE HAMPDEN","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"219 FOGLER RD","madd2":"","madd3":"","mcity":"EXETER","mstate":"ME","mzip":"04435","pcpfaxno":3304534263,"pcpnpi":1811559198,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2MK4MF2JW64","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L570","D225","L814","L821","Z7189","R590","Z5112","Z0000","R053","I10","R059","C61","R102","C649","R911","C641","Z01818","C7802","J188","C7800","Z85528","N200","N281","B356","J168","J181","J189","Z8546","B353","Z08","Z85820","D485","R208","L538","C3432","R0602","Z8701","Z1211","Z86010","D120","D122","C3490","K529","Z0001","R918","Z0100","Z48813","R9389","R7989","R042","J90","J988","R942","J982","H5712","T1502XA","Z9079","Z905","Z48816","J984","B9689","K769","L986","J939","J9811","E7800","R739","Z0101","Z4682","H5203","Z85118","R7303","R079","D1801","K5900","N5089","L720","L905","N393","R9720","M899","N400","K903","R6889"],"date":["2025-11-06","2025-05-02","2025-11-06","2025-11-06","2025-11-06","2025-05-05","2025-10-09","2025-01-29","2025-11-13","2025-05-06","2025-09-22","2024-12-13","2024-12-06","2025-10-22","2025-11-13","2025-11-05","2022-11-29","2025-11-13","2025-09-29","2025-09-03","2025-08-27","2025-05-21","2025-05-21","2023-11-19","2024-11-18","2025-10-08","2025-01-29","2024-06-28","2025-05-29","2025-05-29","2025-05-29","2025-05-29","2025-05-29","2025-05-29","2025-01-10","2025-09-22","2024-10-25","2023-02-10","2023-02-10","2023-02-10","2023-02-10","2025-10-08","2025-08-28","2024-01-08","2025-01-17","2024-02-06","2025-01-22","2024-08-13","2024-08-09","2024-09-06","2025-01-22","2025-05-05","2025-05-05","2025-01-11","2024-03-19","2024-03-19","2023-09-08","2023-05-16","2023-01-31","2025-10-08","2025-10-08","2025-10-22","2023-04-26","2025-01-11","2025-01-11","2022-12-28","2022-12-28","2025-08-05","2025-01-11","2025-08-05","2025-08-27","2024-08-07","2025-09-22","2025-11-06","2023-01-03","2023-01-03","2022-10-13","2022-10-13","2022-10-12","2022-08-16","2022-08-16","2022-08-16","2022-08-03","2022-06-16"],"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":[["","","FAMOTIDINE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","CABOMETYX","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","LACTULOSE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","CLENPIQ","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","POLYMYXIN B SUL-TRIMETHOPRIM","","","Select","Select",""],["","","CICLOPIROX","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","TAMSULOSIN HCL","","","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":""}]}]}