{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Denise K Birkel","gend":1,"currentgend":"","add":"15 MARCH CIR","city":"BANGOR","state":"ME","zip":"04401","dob":"1951-07-15","age":"","mstatus":"","insh":"10000062799","cliId":"","pno":2079428643,"cno":"","email":"declined@07242025.com","ename":"","eno":"","pphy":"SIDHU, VIRINDER","ppno":8145805600,"pcpadd":"302 HUSSON AVE STE 2,","pcpcity":"BANGOR","pcpstate":"ME","pcpzip":"44013373","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"15 MARCH CIR","madd2":"","madd3":"","mcity":"BANGOR","mstate":"ME","mzip":"04401","pcpfaxno":8144552584,"pcpnpi":1891292355,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8RK1D40NG32","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1151","Z01411","L601","K8020","H4312","H348320","E1122","Z0101","H40013","N870","R87612","H538","E119","H40033","N888","E1165","R87610","Z1211","L821","D225","L814","L089","D485","E782","E039","C9211","Z01419","C4441","C44319","Z7984","B351","Z79890","Z0000","L97519","Z4802","Z48817","E785","K5900","D2272","M1611","Z1231","M810","R7303","S0100XA","Z7189","Z08","Z85828","B360","E0500","H4922","H6592","R208","C44722","L658","Z713","M79621","Z0001","R87619","Z7722","I6523","N1830","Z0189","H938X3","R0982","Z780","L820","Z6822","Z0100","Z9481","Z1239","H0520","Z961","M79674","Z7982"],"date":["2024-07-22","2024-07-22","2025-06-04","2022-11-30","2025-08-28","2024-10-29","2025-07-25","2025-03-04","2025-03-04","2025-03-19","2025-03-19","2024-10-29","2024-10-30","2025-09-04","2024-09-12","2023-10-26","2023-01-18","2024-10-01","2024-10-17","2024-10-17","2024-10-17","2023-10-26","2025-04-18","2023-10-26","2025-07-25","2023-10-26","2025-03-19","2025-05-12","2024-10-17","2023-03-28","2025-05-13","2025-05-13","2023-10-26","2023-10-26","2023-10-26","2023-10-26","2024-10-30","2022-12-03","2024-10-17","2025-01-18","2025-04-01","2025-07-25","2022-11-21","2023-10-06","2023-10-06","2023-10-06","2023-10-06","2023-04-05","2023-04-25","2023-04-25","2024-01-05","2025-07-25","2025-05-12","2025-05-12","2023-02-02","2024-04-03","2025-07-24","2024-09-12","2025-03-19","2023-04-19","2022-11-29","2024-04-30","2024-11-14","2024-11-14","2024-04-19","2024-10-17","2023-02-02","2023-02-27","2022-10-24","2022-10-24","2022-11-03","2022-06-28","2022-06-30","2022-06-30"],"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":[["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY READER","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","FREESTYLE LIBRE 3 READER","","","Select","Select",""],["","","CICLOPIROX","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FREESTYLE LIBRE 2 READER","","","Select","Select",""],["","","FREESTYLE TEST STRIPS","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","DORZOLAMIDE HCL","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HYDROCORT","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY SENSOR","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","FREESTYLE LANCETS","","","Select","Select",""],["","","KETOCONAZOLE","","","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":{"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}