{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John H Albertini","gend":0,"currentgend":"","add":"1158 DOVER RD","city":"CHARLESTON","state":"ME","zip":"04422","dob":"1954-05-29","age":"","mstatus":"","insh":"10000070592","cliId":"","pno":2072850008,"cno":"","email":"john.albertini@gmail.com","ename":"","eno":"","pphy":"LODATO, ROBERT J","ppno":2072853435,"pcpadd":"Northern Light Primary Care Corinth,492 Main St","pcpcity":"Dexter","pcpstate":"ME","pcpzip":"04930","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE CORINTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1158 DOVER RD","madd2":"","madd3":"","mcity":"CHARLESTON","mstate":"ME","mzip":"04422","pcpfaxno":2079245992,"pcpnpi":1811931249,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7KV4E09JE80","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N401","D225","D2271","L821","Z7189","Z1211","I2510","Z122","E119","Z0000","M7662","D123","D125","K635","N2889","H35371","Z0101","I252","Z87891","R0602","L8990","I10","E785","R918","I493","R9431","R3915","N3289","D124","K8020","N281","K5730","L570","Z125","Z13818","R351","R350","R931","Z0001","I639","I5189","M19072","J069","R059","I6529","Z8673","L814","Z09","Z7902","G468","L89329","L89309","I6782","R42","I6389"],"date":["2024-04-26","2024-07-30","2024-07-30","2024-07-30","2023-07-27","2024-12-11","2025-10-22","2025-01-31","2025-10-09","2025-10-13","2025-01-22","2024-12-11","2024-12-11","2024-12-11","2024-05-07","2024-10-30","2024-10-30","2025-09-24","2025-01-31","2025-10-01","2023-01-17","2025-10-09","2025-10-09","2023-11-10","2025-09-08","2025-09-08","2023-08-01","2023-08-01","2024-12-11","2025-08-01","2025-08-01","2025-08-01","2025-08-06","2025-07-23","2025-08-01","2023-07-18","2024-06-06","2025-09-16","2025-07-23","2025-08-29","2025-08-29","2025-01-22","2025-01-30","2025-01-30","2025-09-17","2024-09-11","2024-07-30","2024-09-11","2024-09-11","2023-05-03","2022-11-10","2022-10-03","2022-06-28","2022-06-28","2022-06-14"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","FLUBLOK TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUOCINONIDE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","ONETOUCH DELICA","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","JARDIANCE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}