{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Suzanne G Hillman","gend":1,"currentgend":"","add":"90 GRANITE ST","city":"Biddeford","state":"ME","zip":"04005","dob":"1958-12-26","age":"","mstatus":"","insh":"10000070811","cliId":"","pno":2072833071,"cno":2075902434,"email":"Suzanne.hillman@yahoo.com","ename":"","eno":"","pphy":"WOOD, BEVERLY J","ppno":"","pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE SOUTH PORTLAND","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"90 GRANITE ST","madd2":"","madd3":"","mcity":"Biddeford","mstate":"ME","mzip":"04005","pcpfaxno":2078287850,"pcpnpi":1922071349,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6CN7A31AW75","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1712","E119","M546","M9900","M9901","Z96652","E1165","I10","E782","E6601","M24662","E669","G8918","M609","Z853","E8352","Z01818","M25562","M9902","Z471","M170","M9903","M9904","M5450","Z7984","Z1211","F4321","Z0000","H35363","E139","R059","R6883","R0989","G8929","D045","Z0001","R6889","M25561","D0471","Z87891","Z23"],"date":["2024-08-05","2025-10-22","2025-07-21","2025-10-15","2025-10-15","2024-10-27","2025-01-14","2025-10-22","2025-10-22","2023-07-13","2024-02-07","2024-02-07","2024-02-07","2024-12-09","2025-03-28","2025-03-28","2023-10-25","2023-08-31","2025-10-15","2024-10-27","2023-07-14","2024-12-09","2024-12-09","2025-10-15","2024-07-24","2025-10-22","2025-04-23","2025-01-22","2025-08-12","2025-08-12","2024-11-27","2024-11-26","2024-11-26","2023-05-09","2023-07-24","2024-01-18","2023-08-03","2025-07-28","2023-07-24","2023-07-24","2022-10-11"],"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":[["","","JANUVIA","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","MELOXICAM","","","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":""}]}]}