{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Faith D Woodbury","gend":1,"currentgend":"","add":"733 TODDS CORNER RD","city":"ST ALBANS","state":"ME","zip":"04971","dob":"1953-11-02","age":"","mstatus":"","insh":"10000065572","cliId":"","pno":2079383240,"cno":"","email":"dutchess0253@yahoo.com","ename":"","eno":"","pphy":"BARATTA, ELIZABETH A","ppno":2079737979,"pcpadd":"Northern Light Family Medicine and Residency,895 Union St Ste 12","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HEALTH CENTER NEWPORT PLAZA","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"733 TODDS CORNER RD","madd2":"","madd3":"","mcity":"ST ALBANS","mstate":"ME","mzip":"04971","pcpfaxno":2079479579,"pcpnpi":1740718261,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9C68MY5KK33","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M21612","I2510","E1165","E6601","Z8679","G4733","F32A","Z1231","R7303","F3289","Z01810","Z0100","M25531","M7732","F3341","Z79899","R1032","Z0000","Z4789","I10","M25511","R1084","Z13820","Z713","M21611","M19031","E782","I252","R079","Z743","Z789","R0789","R918","J069","R0782","E669","I519","I213","Z7901","E119"],"date":["2023-11-29","2024-06-04","2024-10-03","2024-05-08","2023-06-28","2023-09-20","2023-09-20","2023-01-30","2023-09-20","2023-01-04","2023-03-28","2024-09-11","2023-03-28","2023-07-18","2023-10-11","2023-10-23","2024-09-09","2024-08-07","2023-07-18","2024-11-27","2024-10-15","2024-09-09","2023-08-24","2023-07-27","2024-05-06","2023-05-30","2023-08-31","2023-08-31","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-09","2022-11-10","2022-11-10","2022-11-10","2022-07-20","2022-05-23","2022-05-23","2022-05-18"],"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":[["","","TRAMADOL HCL","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","ROPINIROLE HCL","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y 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":""}]}]}