{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Barbara A Jay","gend":1,"currentgend":"","add":"129 RIVERSIDE ST","city":"Milo","state":"ME","zip":"04463","dob":"1952-08-07","age":"","mstatus":"","insh":"10000062995","cliId":"","pno":2079432711,"cno":"","email":"Sammie40.jay@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":"129 RIVERSIDE ST","madd2":"","madd3":"","mcity":"Milo","mstate":"ME","mzip":"04463","pcpfaxno":2079890551,"pcpnpi":1336189109,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3HE3PD9NP73","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M9902","M546","M9908","M9903","M47816","Z4789","M5450","L570","L821","L218","D2239","D225","C44719","S299XXA","S3992XA","M4802","G959","M4150","H548","S0990XA","Z1231","Z09","M19072","S79911A","D509","S069X0A","M21612","M7732","N1831","Z48816","R197","H2012","H01006","H01003","M4322","K2100","M25572","M79671","S199XXA","Z0100","Z87891","M5011","M4722","M4712","Z48811","M2142","H40023","Z0000","M4180","G8929","R296","Z981","R7989","E669","M8589","H26492","M25522","W1830XA","R6889","M5136","Z98890","M47812","M170","M25562","M25561","H26493","R350","R140","U099","M549","M25551","M4312","M5021","L814","Z808","M79672","J449","Z0001","S20161A","W57XXXA","M5410","R2240","M1990","K219","M19022","K449","K589","Z79899","Z862","R918","S93602S","M48061","M5127","M47817","I454","D485","L298","M7989","J189","D649","M898X5","D2272","L720","K319","R1010"],"date":["2024-10-07","2024-10-07","2024-10-07","2024-10-07","2024-11-15","2025-03-21","2024-08-02","2025-04-29","2025-04-29","2023-08-07","2023-08-07","2025-04-29","2024-10-28","2024-02-12","2024-04-24","2025-02-15","2025-01-13","2025-01-13","2025-01-13","2025-01-24","2025-08-28","2023-09-21","2025-08-26","2024-04-24","2025-03-25","2025-01-24","2023-05-09","2023-04-05","2025-03-12","2025-02-26","2022-10-24","2024-01-18","2024-01-18","2024-01-18","2025-02-26","2025-01-16","2022-12-29","2022-12-29","2025-08-21","2024-03-13","2024-10-09","2024-10-03","2024-10-03","2024-10-03","2025-05-13","2023-05-09","2024-04-24","2024-05-06","2025-08-21","2024-07-01","2024-07-01","2025-05-13","2023-08-18","2023-02-10","2022-11-21","2023-04-11","2023-06-01","2023-06-01","2024-02-13","2024-03-22","2023-04-05","2024-06-15","2022-10-21","2022-10-21","2022-10-21","2024-01-05","2024-03-20","2022-10-24","2022-10-24","2024-03-20","2024-03-20","2024-10-03","2024-06-15","2025-04-29","2025-04-29","2022-12-29","2025-02-19","2025-05-12","2023-10-16","2023-10-16","2024-04-08","2024-04-08","2024-04-08","2024-07-19","2023-06-01","2024-07-19","2024-07-19","2024-07-19","2023-03-21","2024-02-23","2022-12-29","2024-03-22","2024-03-22","2024-03-22","2023-08-18","2024-09-18","2024-09-18","2024-06-04","2024-02-23","2023-04-17","2024-06-04","2022-07-25","2022-07-25","2022-07-07","2022-07-07"],"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",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","GENTAMICIN SULFATE","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","TRIAMTERENE-HYDROCHLOROTHIAZID","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","RALOXIFENE HCL","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","KLAYESTA","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","NYSTOP","","","Select","Select",""],["","","CYCLOSPORINE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","GABAPENTIN","","","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":""}]}]}