{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Deborah W Marshall","gend":1,"currentgend":"","add":"45 LITTLE DEER ISLE RD","city":"LITTLE DEER ISLE","state":"ME","zip":"04650","dob":"1939-08-21","age":"","mstatus":"","insh":"10000069622","cliId":"","pno":2073482648,"cno":"","email":"deb@coveside.net","ename":"","eno":"","pphy":"DEL MUNDO, WINFRED F","ppno":2076647770,"pcpadd":"Ellsworth Family Practice,32 Resort Way","pcpcity":"Ellsworth","pcpstate":"ME","pcpzip":"04605","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 67","madd2":"","madd3":"","mcity":"LITTLE DEER ISLE","mstate":"ME","mzip":"04650","pcpfaxno":2076647723,"pcpnpi":1417925116,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6NQ7T09TP72","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I110","I5020","R0602","R200","M9900","R748","F411","I4891","E871","I4811","J029","U071","L989","L570","R7989","R002","K7689","L600","G609","B351","C44321","D485","L578","L821","Z85828","E785","J449","J90","K769","I2510","M9901","J439","R918","G8929","N390","J22","I4819","I351","S0990XA","G43109","S20212A","R1030","R4781","S2020XA","S3991XA","S3993XA","H04123","H43813","H26493","H01022","S199XXA","H43811","L281","F419","I340"],"date":["2025-04-17","2024-07-15","2024-05-15","2025-02-14","2025-06-23","2025-07-08","2025-03-13","2025-05-15","2025-06-05","2024-04-30","2022-12-28","2024-03-11","2025-04-07","2025-01-30","2025-04-04","2024-02-14","2025-06-12","2025-08-13","2025-08-13","2025-08-13","2024-07-10","2024-04-03","2025-01-30","2025-01-30","2025-01-30","2025-03-13","2025-03-13","2024-05-16","2024-06-17","2025-02-21","2024-11-18","2025-05-12","2025-05-12","2024-06-14","2025-06-11","2024-03-14","2024-05-16","2024-02-29","2024-05-10","2022-12-05","2024-05-10","2024-05-10","2024-05-10","2024-05-10","2024-05-10","2024-05-10","2024-09-30","2024-09-30","2024-09-30","2024-09-30","2024-05-10","2022-09-21","2022-09-06","2022-07-21","2022-07-29"],"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":[["","","CLONAZEPAM","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","SYMBICORT","","","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":""}]}]}