{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robin L Vernott","gend":1,"currentgend":"","add":"981 STATE HWY 150","city":"Guilford","state":"ME","zip":"04443","dob":"1958-04-30","age":"","mstatus":"","insh":"10000069565","cliId":"","pno":2072773682,"cno":"","email":"declined@email.com","ename":"","eno":"","pphy":"ROOPE, SHELLY L","ppno":2078764811,"pcpadd":"22 HALEY CT,","pcpcity":"SANGERVILLE","pcpstate":"ME","pcpzip":"44793000","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE SANGERVILLE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"981 STATE HWY 150","madd2":"","madd3":"","mcity":"Guilford","mstate":"ME","mzip":"04443","pcpfaxno":2078764302,"pcpnpi":1487021259,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3DP5E72KG55","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","J441","I110","I5181","I5033","N179","E039","E785","I428","R0602","F331","G4733","M4802","M4722","L03116","E860","I447","R059","I509","I6523","R0603","J449","Z0001","I3139","R928","Z1231","G4730","S91302A","M47814","M5010","R21","R197","I5021","I252","R0600","Z87891","Z7951","Z981","R0683","M5450","M549","I10","M5431","R062","J9601","I214","E8342","I5042","I429","I454","M5416","M48062","F05","Z6841","M5412","R942","M546","R7303","I21A1","I5043","M5137","L308","Z48811","L089","R69","K529","Z09","M48061","E119","Z1211","M5117","J101","Z4789","I700","R531","E669","R791","I340","I5030","D120","K6389","R9431","D7589","J9621","F10939","L252","Z01818","F321","M1712","R918","M5127","M47817","M2578"],"date":["2025-04-04","2023-11-22","2025-07-02","2023-10-17","2023-10-12","2023-03-31","2025-05-01","2023-11-22","2023-11-22","2024-02-04","2022-11-10","2025-09-08","2025-02-10","2025-02-10","2024-07-22","2023-03-07","2024-01-11","2023-11-14","2024-08-01","2025-02-05","2023-11-21","2024-02-04","2025-03-28","2023-10-11","2023-09-29","2024-10-01","2024-11-13","2024-07-22","2025-01-20","2025-01-20","2025-04-22","2024-06-19","2024-01-19","2023-11-01","2024-06-04","2025-04-22","2024-06-04","2023-04-14","2023-06-02","2022-12-13","2025-02-03","2022-12-29","2022-12-29","2023-11-14","2023-04-27","2023-05-24","2023-04-27","2023-10-14","2024-01-19","2024-01-19","2023-02-24","2023-03-31","2023-03-31","2023-03-31","2025-05-15","2024-06-04","2025-01-29","2024-09-19","2023-10-17","2023-10-17","2023-07-10","2024-09-18","2023-07-10","2024-03-18","2023-10-27","2024-06-28","2023-04-18","2023-04-14","2025-07-09","2024-08-08","2022-12-22","2024-02-04","2023-04-07","2024-02-27","2023-02-24","2023-02-24","2023-04-24","2023-04-25","2023-04-25","2024-08-08","2024-08-08","2022-12-28","2022-12-28","2023-10-12","2023-10-12","2024-03-22","2023-03-01","2024-04-10","2024-04-10","2023-04-24","2023-01-19","2023-01-19","2023-01-19"],"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":[["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","HALOBETASOL PROPIONATE","","","Select","Select",""],["","","ISOSORBIDE DINITRATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","SYNTHROID","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LISINOPRIL","","","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":""}]}]}