{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Wayne A Carter","gend":0,"currentgend":"","add":"270 CENTRAL ST","city":"BUCKSPORT","state":"ME","zip":"04416","dob":"1968-07-09","age":"","mstatus":"","insh":"10000061510","cliId":"","pno":2079020683,"cno":"","email":"Ccarter6352@gmail.com","ename":"","eno":"","pphy":"HATCH CLEIN, ANNETTE M","ppno":2079890550,"pcpadd":"43 WHITING HILL RD STE 300,","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121006","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"270 CENTRAL ST","madd2":"","madd3":"","mcity":"BUCKSPORT","mstate":"ME","mzip":"04416","pcpfaxno":2079890551,"pcpnpi":1336189109,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3E66GD3UK73","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R5383","E7800","Z0000","M5412","L570","B078","L538","D485","F319","F411","F1220","M5410","M79672","M7742","M2679","M62562","M5417","M5136","Z8249","L281","Z125","Z0101","H524","M48061","F1290","H2513","M25511","F17210","M65811","M5416","Z0001","M19011","K219","R6889","Z801","R682","K121","Z87891","M5116","M4727","H5203","H52223","E781","Z720","M25551","M542","Z23","M47812","M4726"],"date":["2023-01-25","2025-09-03","2025-05-30","2023-01-25","2025-07-24","2025-07-24","2025-07-24","2025-07-24","2025-05-30","2023-02-06","2023-02-06","2023-05-30","2025-04-28","2025-04-28","2024-08-28","2025-05-30","2023-07-21","2023-07-21","2023-07-21","2025-07-24","2023-01-25","2024-08-15","2024-08-15","2023-01-13","2023-01-13","2022-12-02","2023-04-05","2024-07-15","2023-03-29","2023-05-19","2025-05-30","2023-03-29","2024-11-26","2023-12-28","2023-01-13","2024-08-28","2024-08-28","2024-08-28","2023-05-19","2023-05-19","2024-08-15","2024-08-15","2025-09-03","2024-07-15","2022-11-22","2022-11-22","2022-11-22","2022-11-22","2022-11-22"],"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":[["","","OMEPRAZOLE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","BETAMETHASONE VALERATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}