{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Stephen L Dunning","gend":0,"currentgend":"","add":"199 BOMARC RD UNIT 1","city":"BANGOR","state":"ME","zip":"04401","dob":"1947-05-15","age":"","mstatus":"","insh":"10000063219","cliId":"","pno":2074789211,"cno":"","email":"thetideride@gmail.com","ename":"","eno":"","pphy":"GRISSOM, AMBER N","ppno":"","pcpadd":"Northern Light Internal Medicine,302 Husson Ave Ste 1","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"199 BOMARC RD UNIT 1","madd2":"","madd3":"","mcity":"BANGOR","mstate":"ME","mzip":"04401","pcpfaxno":2079735042,"pcpnpi":1689177867,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4KK2NT0JV92","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K9130","I5022","I110","E669","I10","I5020","I70213","I509","E785","N401","I255","R21","D225","L814","L821","Z08","Z466","N281","Z7984","K649","Z9049","Z48815","S1096XA","Z20822","I517","K760","S46911A","K429","I429","Z0000","R7303","I2510","L820","L538","L570","Z7189","I252","Z955","R7301","Z5181","Z23","S40261A","W57XXXA","Z87891","K439","R1084","R109","R0609","K6389","R338","R350","R351","Z0001","G4700","K635","K5790","Z7982","Z961"],"date":["2023-07-30","2025-03-17","2025-03-17","2023-07-30","2024-07-23","2024-07-23","2022-11-15","2025-04-04","2025-03-17","2025-03-25","2025-05-09","2025-06-16","2025-08-27","2025-08-27","2025-08-27","2025-08-27","2023-11-17","2024-10-10","2023-11-10","2023-08-17","2023-08-17","2023-08-17","2025-06-16","2023-01-24","2023-06-22","2024-11-19","2024-12-11","2023-05-09","2024-07-23","2025-03-17","2025-04-04","2025-05-16","2022-11-10","2022-11-10","2022-11-10","2025-02-27","2024-05-30","2024-05-30","2024-10-08","2024-10-08","2022-11-02","2025-06-16","2025-06-16","2025-06-16","2023-04-21","2023-04-21","2023-04-21","2023-02-24","2023-07-29","2024-03-26","2024-03-26","2024-03-26","2022-08-25","2022-08-25","2022-06-23","2022-06-23","2022-06-23","2022-06-14"],"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":[["","","FINASTERIDE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","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":""}]}]}