{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Deborah J Somers","gend":1,"currentgend":"","add":"46 PATTERSON ST","city":"HAMPDEN","state":"ME","zip":"04444","dob":"1954-02-04","age":"","mstatus":"","insh":"10000066886","cliId":"","pno":2077457909,"cno":"","email":"some220@aol.com","ename":"","eno":"","pphy":"SAUNDERS, KATHERINE ANNE","ppno":2078629400,"pcpadd":"\tEMMC Family Medicine of Hampden\t,7 Main Rd N","pcpcity":"Hampden","pcpstate":"ME","pcpzip":"04444","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE HAMPDEN","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"46 PATTERSON ST","madd2":"","madd3":"","mcity":"HAMPDEN","mstate":"ME","mzip":"04444","pcpfaxno":2078629411,"pcpnpi":1295161883,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8TE3F41DT06","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E6601","I10","M150","E039","K219","H2511","G4730","S8252XD","S82142D","X58XXXD","K449","S8252XA","G8929","M79602","E782","Z0001","Z6836","F419","R4586","Z7982","Z6835","Z23","Z0000","Z79899","R7303","G4733","L918","Z0101","M25512","K317","M461","H3554","M549","M533","M5137","M47816","M4316","S82852A","W19XXXA","S82122A","Z1231","S3993XA","Z9989","S82832D","Z4789","R197","E785","J069","R6889","S82892A","S82142A","Z780","M8588","R0602","I340","R61","H2512","K319","G8918","M160","K5900","S82122D","K2100","R0683","M5136","H353131","R5383","S82892D","M19012","Z13820","Z20822","B349","M542"],"date":["2025-09-02","2025-09-02","2024-04-06","2024-04-06","2025-07-28","2024-07-23","2024-04-17","2025-05-27","2025-07-07","2025-05-27","2025-07-28","2025-04-30","2024-12-24","2023-10-18","2023-08-17","2025-09-02","2025-09-02","2024-12-24","2024-12-24","2024-12-24","2024-04-17","2023-10-31","2024-08-16","2023-08-18","2024-08-16","2024-08-16","2023-09-15","2025-08-01","2023-08-03","2025-07-28","2025-03-13","2025-08-01","2025-03-19","2023-08-15","2023-07-25","2023-06-30","2023-07-25","2025-04-15","2025-04-17","2025-04-14","2025-09-11","2025-04-13","2024-06-12","2025-04-17","2025-04-14","2023-10-13","2023-10-13","2023-02-16","2023-09-29","2025-04-30","2025-04-30","2024-10-31","2024-10-31","2023-10-04","2023-10-04","2024-12-12","2024-07-30","2025-07-28","2025-04-14","2024-10-07","2024-10-07","2025-04-14","2024-10-15","2023-10-16","2023-07-25","2024-05-24","2023-09-18","2025-07-07","2023-10-18","2024-10-31","2023-01-04","2022-07-04","2022-06-23"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","OXYCODONE HCL","","","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":""}]}]}