{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Catherine L Crowell","gend":1,"currentgend":"","add":"5 KILLARNEY CT","city":"Veazie","state":"ME","zip":"04401","dob":"1953-05-17","age":"","mstatus":"","insh":"10000060625","cliId":"","pno":2072977252,"cno":"","email":"ccrowell437@gmail.com","ename":"","eno":"","pphy":"OCONNELL, KRISTOPHER L","ppno":2078629400,"pcpadd":"43 WHITING HILL RD,SUITE 300","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121005","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE HAMPDEN","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5 KILLARNEY CT","madd2":"","madd3":"","mcity":"Veazie","mstate":"ME","mzip":"04401","pcpfaxno":2079735042,"pcpnpi":1881993475,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9P47H70YH49","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4891","I493","Z1211","D125","K635","Z800","E039","H401132","H43393","Z1231","M810","Z1239","R5383","Z7901","I10","Z0101","H52223","K219","K644","Z23","N909","I509","M8589","H43813","R9431","D6869","N898","R030","R059","J329","J984","R1011","R946","E871","N134","R1013","R7989","I480","I083","Z0000","Z01419","Z124","H3561","H401130","Z961","I4819","Z87891","R6889","S299XXA","S79911A","S79912A","S0990XA","S20211A","R300","S39011A"],"date":["2025-09-04","2024-01-08","2025-01-28","2025-01-28","2025-01-28","2025-01-28","2025-06-02","2025-05-13","2024-08-21","2025-01-09","2024-09-10","2023-01-06","2023-04-07","2025-08-01","2024-10-15","2025-07-09","2025-07-09","2024-12-10","2025-07-02","2024-11-15","2025-05-31","2023-12-04","2024-01-08","2025-04-02","2024-01-23","2024-10-15","2025-05-23","2023-05-09","2023-05-09","2023-05-09","2023-05-09","2025-06-18","2023-12-04","2025-06-18","2025-06-18","2025-06-18","2023-12-05","2024-10-15","2025-06-11","2024-09-10","2023-08-30","2023-08-30","2025-09-10","2025-09-10","2025-09-10","2025-08-04","2025-08-01","2023-01-01","2024-09-19","2024-09-19","2024-09-19","2024-09-19","2024-09-19","2025-05-10","2024-09-26"],"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":[["","","ESTRADIOL","","","Select","Select",""],["","","PROPRANOLOL HCL ER","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLECAINIDE ACETATE","","","Select","Select",""],["","","DORZOLAMIDE-TIMOLOL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","YUVAFEM","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","PREDNISONE","","","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":""}]}]}