{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"William R Hemenway","gend":0,"currentgend":"","add":"660 ELM ST","city":"MILO","state":"ME","zip":"04463","dob":"1954-04-19","age":"","mstatus":"","insh":"10000066847","cliId":"","pno":2077231170,"cno":"","email":"","ename":"","eno":"","pphy":"VANDERMAST, DIANA M","ppno":2079437752,"pcpadd":"PO BOX 1129,","pcpcity":"GREENVILLE","pcpstate":"ME","pcpzip":"44411129","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE MILO","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"660 ELM ST","madd2":"","madd3":"","mcity":"MILO","mstate":"ME","mzip":"04463","pcpfaxno":2076952329,"pcpnpi":1669423349,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2NT8EH0HP64","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K7030","K7460","K820","N281","R2231","I110","Z4802","R531","S6991XA","Z0000","Z09","E871","S01412A","K7401","I5032","I4891","I493","I4510","R413","E8342","L03113","I10","E854","I428","I071","I7121","Z0100","M1712","R52","L03011","F10230","M6281","Z0101","H524","H3561","H43813","K828","M25562","R262","S01112A","S0083XA","R4182","H0259","I509","I082","I088","I77810","I513","I480","I5089","F1090","I4819","J9600","E876","J9691","E859","J9690","Z9989","R0989","Z4682","I081","R7889","Z1211","Z1212","I5030","M19032","S0181XA","I3139","K5730","I4811","D696","D649","R768","D7589","Z01818","R803","I498","I712","Z87891","I454","I472","R0602","M7989"],"date":["2025-02-20","2024-11-14","2024-11-14","2024-11-14","2023-11-17","2024-04-24","2025-09-30","2023-11-17","2023-11-17","2025-11-12","2023-12-01","2025-10-17","2025-09-23","2025-02-20","2024-12-18","2025-08-06","2024-06-14","2024-06-14","2025-08-06","2023-12-01","2023-11-24","2023-09-06","2023-09-06","2023-09-06","2025-02-27","2024-12-18","2025-07-31","2025-09-02","2023-11-17","2023-11-24","2023-11-24","2023-11-24","2023-08-31","2023-08-31","2023-08-31","2023-08-31","2024-05-08","2025-06-04","2023-11-24","2025-09-30","2025-09-30","2023-09-13","2023-09-13","2025-10-09","2023-09-18","2024-02-28","2024-02-28","2024-02-28","2024-12-18","2023-09-16","2023-09-16","2023-09-14","2023-09-14","2025-08-12","2023-09-14","2023-09-14","2023-09-14","2023-09-14","2023-09-14","2023-09-14","2024-02-28","2025-02-27","2024-01-18","2024-01-18","2023-02-15","2023-09-29","2025-10-09","2023-02-15","2023-11-17","2022-10-06","2022-10-06","2022-10-06","2022-08-08","2022-08-08","2022-08-23","2022-07-22","2022-08-03","2022-08-01","2022-08-01","2022-06-30","2022-06-30","2022-02-10","2022-02-10"],"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":[["","","BUMETANIDE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","DABIGATRAN ETEXILATE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","WARFARIN SODIUM","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}