{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Libbey Gulliver","gend":1,"currentgend":"","add":"49 PLEASANT ST","city":"BLUE HILL","state":"ME","zip":"04614","dob":"1953-08-27","age":"","mstatus":"","insh":"10000061631","cliId":"","pno":2076643344,"cno":"","email":"libbeygulliver@yahoo.com","ename":"","eno":"","pphy":"LESKO, LISA A","ppno":2073742311,"pcpadd":"Blue Hill Family Medicine,57 Water St","pcpcity":"Blue Hill","pcpstate":"ME","pcpzip":"04614","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BLUE HILL","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 449","madd2":"","madd3":"","mcity":"BLUE HILL","mstate":"ME","mzip":"04614","pcpfaxno":2073742618,"pcpnpi":1720022866,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2M71Y73VJ03","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","H2511","R0789","M75112","M25562","Z23","M1611","M7061","E66811","F4323","E785","M1990","M859","H26492","M19012","Z0001","H26491","Z1231","I2510","M25551","H2512","M25512","D225","L821","L814","Z7189","Z0100","R079","R0602","H01021","H01024","H04123","G4730","M160","M75102","H43813","M810","R6889","Z13820","H26493","Z08","Z20822"],"date":["2025-02-04","2023-07-26","2025-03-27","2024-11-04","2024-10-09","2024-10-08","2024-01-10","2024-01-10","2025-01-27","2024-02-26","2023-04-05","2023-11-09","2023-04-05","2024-12-30","2024-09-10","2025-06-13","2024-12-19","2024-08-26","2025-07-17","2024-08-28","2023-07-24","2024-09-10","2024-09-04","2025-09-08","2025-09-08","2025-09-08","2023-11-02","2025-03-27","2025-03-27","2023-06-20","2023-06-20","2024-12-10","2025-02-21","2023-09-26","2024-09-10","2024-12-10","2025-03-11","2023-01-01","2025-03-11","2023-12-05","2025-09-08","2022-08-30"],"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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","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":""}]}]}