{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Peter R Bolduc","gend":0,"currentgend":"","add":"301 BASSETT RD","city":"Winslow","state":"ME","zip":"04901","dob":"1954-06-05","age":"","mstatus":"","insh":"10000068655","cliId":"","pno":2078593030,"cno":"","email":"","ename":"","eno":"","pphy":"KRIEGEL, CHARLES B","ppno":"","pcpadd":"Sebasticook Valley Health,80 Main St","pcpcity":"Unity","pcpstate":"ME","pcpzip":"04988","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HEALTH CENTER UNITY","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"301 BASSETT RD","madd2":"","madd3":"","mcity":"Winslow","mstate":"ME","mzip":"04901","pcpfaxno":2078613281,"pcpnpi":1497800734,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5VW6NV3FG81","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I5020","I77810","I080","I255","Z0000","E785","I4891","I2510","R9720","K811","Z0101","H25813","H5203","I5022","I25119","I480","Z7689","Z79899","G894","Z951","Z09","Z9049","C61","M5450","I509","R109","K810","Z743","R110","K429","J449","Z7901","R079","J9859","K8020","K838","S3991XA","S2243XA","J929","K5730","I517","J8410","I110","R69","Z87891","Z7951","I252","K8070","R32","Z9079","Z122","N401","R351","R3912","L84","Q453","K449","I083","I77819","R222","K4020","R6889","M79671","K8050","Z0001","N400","I10","R942","I5040","Z8719","K2970","R160","K56609","K6389","K5900","N179","K56600","Z20822","R1030","K56699","R1110","Z789","J302"],"date":["2025-01-07","2025-01-07","2025-01-07","2025-01-07","2024-11-12","2024-11-12","2024-11-12","2024-11-12","2023-12-14","2024-04-02","2024-02-29","2024-02-29","2024-02-29","2024-09-05","2024-09-05","2024-09-05","2025-07-11","2024-11-12","2024-11-12","2023-07-25","2024-04-09","2024-04-09","2025-03-04","2024-04-09","2024-05-28","2024-03-31","2024-03-31","2024-03-31","2023-04-28","2024-07-31","2024-05-28","2024-05-28","2024-03-31","2024-06-06","2024-03-31","2024-03-31","2024-03-31","2023-04-29","2023-04-29","2023-04-29","2023-01-11","2023-11-21","2023-11-16","2024-04-12","2024-05-09","2023-11-21","2024-03-31","2024-04-02","2024-12-03","2024-12-03","2023-06-15","2023-12-14","2023-12-14","2023-11-09","2024-03-07","2024-04-02","2024-04-02","2024-05-23","2024-05-23","2024-05-23","2023-12-06","2023-02-20","2024-03-07","2024-04-02","2022-11-17","2022-11-17","2022-10-13","2022-08-10","2022-08-01","2022-07-26","2022-07-26","2022-07-26","2022-07-12","2022-07-11","2022-07-11","2022-07-12","2022-07-11","2022-07-11","2022-07-11","2022-07-11","2022-07-11","2022-07-11","2022-07-06"],"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":[["","","OMEPRAZOLE","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","GAVILYTE-N","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CAPTOPRIL","","","Select","Select",""],["","","PREVNAR 20","","","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":""}]}]}