{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Linda A Gagnon","gend":1,"currentgend":"","add":"16 SOUTH ST","city":"PRESQUE ISLE","state":"ME","zip":"04769","dob":"1953-07-02","age":"","mstatus":"","insh":"10000061739","cliId":"","pno":2077627401,"cno":"","email":"","ename":"","eno":"","pphy":"Guerrette, Kristin M","ppno":2077643142,"pcpadd":"23 NORTH ST STE 4,","pcpcity":"PRESQUE ISLE","pcpstate":"ME","pcpzip":"47692295","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE PRESQUE ISLE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"16 SOUTH ST","madd2":"","madd3":"","mcity":"PRESQUE ISLE","mstate":"ME","mzip":"04769","pcpfaxno":2077608170,"pcpnpi":1942643770,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8FK4CN1DU01","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C541","R590","Z5111","N950","Z1231","R92323","I10","N200","Z23","Z0130","N390","E210","Z452","Z79899","H40023","R109","N939","R1084","Z90710","Z1509","K5900","D6489","Z0001","E876","Z01818","C778","E785","E039","R4182","Z0000","Z13820","N1830","M859","I129","R7303","H25813","H43812","H538","N83201","N83202","D649","K5909","R921","M8588"],"date":["2025-06-09","2024-12-31","2025-04-07","2024-09-18","2025-06-10","2025-06-10","2025-03-13","2024-09-18","2024-09-18","2025-02-25","2024-12-30","2024-09-24","2025-02-16","2025-02-16","2025-03-25","2024-09-14","2024-09-14","2024-09-14","2024-12-30","2025-05-19","2025-03-17","2025-05-19","2023-03-08","2024-11-16","2025-02-12","2025-02-10","2024-12-03","2024-12-03","2024-12-03","2025-06-04","2023-11-28","2023-11-01","2023-11-01","2023-03-08","2022-12-29","2023-02-14","2023-02-14","2023-02-14","2024-12-03","2024-12-03","2025-02-24","2025-05-19","2023-05-22","2023-11-28"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","PNEUMOVAX 23","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","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":""}]}]}