{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Linda J Rines","gend":1,"currentgend":"","add":"37 POPLAR ROAD","city":"BANGOR","state":"ME","zip":"04401","dob":"1952-03-09","age":"","mstatus":"","insh":"10000064460","cliId":"","pno":2079425914,"cno":"","email":"noemail@103023.com","ename":"","eno":"","pphy":"KANUMALLA, RAGHU","ppno":2079890550,"pcpadd":"Northern Light Primary Care Brewer,234 State St","pcpcity":"Brewer","pcpstate":"ME","pcpzip":"04412","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"37 POPLAR RD","madd2":"","madd3":"","mcity":"GLENBURN","mstate":"ME","mzip":"04401","pcpfaxno":2079890551,"pcpnpi":1497313696,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3TQ6UF3DH77","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R300","H35372","Z87440","Z79899","D3131","D3132","G8929","N390","R600","Z0001","Z79891","G7000","G35","I480","H50111","H2511","H35342","H2512","R399","Z461","R221","Z48810","I340","M47814","E042","E785","Z1231","H25813","R350","M961","M47816","M47817","M5137","R319","Z961","Z87891","Z83511","M5450","G894","Z7982","L209","Z780","H2513","N6489","I491","N319","R3915","N393","M797","M62838","I2720","I081","Z7901","F4542","Z8542","Z0389","R109","M5136","E6601"],"date":["2024-07-02","2025-06-02","2023-09-01","2023-12-13","2024-07-02","2024-07-02","2025-02-04","2025-07-31","2023-04-11","2023-01-06","2024-10-08","2023-12-13","2025-04-30","2025-02-19","2025-08-12","2024-10-28","2024-09-24","2024-10-21","2023-05-25","2025-09-09","2024-02-23","2025-08-19","2022-11-10","2024-01-12","2024-02-23","2024-02-20","2023-08-04","2024-03-18","2023-12-13","2024-10-08","2023-09-15","2023-09-15","2023-09-15","2023-09-01","2025-06-02","2025-06-02","2025-06-02","2024-10-08","2023-07-10","2023-08-03","2024-05-15","2023-08-04","2024-10-21","2022-10-24","2025-03-17","2023-08-03","2023-08-03","2023-08-03","2022-12-13","2023-11-09","2025-02-19","2025-02-19","2025-05-21","2023-11-09","2023-11-09","2023-12-15","2022-09-20","2022-07-21","2022-07-21"],"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":[["","","XARELTO","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","PYRIDOSTIGMINE BROMIDE","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","TOBRAMYCIN","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","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":{"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":[]}},{"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":""}]}]}