{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Camilla A Adams","gend":1,"currentgend":"","add":"112 BAKER RD","city":"FREEPORT","state":"ME","zip":"04032","dob":"1954-11-24","age":"","mstatus":"","insh":"10000071054","cliId":"","pno":2078653510,"cno":"","email":"ladycamilla@hotmail.com","ename":"","eno":"","pphy":"Newcombe, Jodi A","ppno":2075351200,"pcpadd":"385 ROUTE 1,","pcpcity":"YARMOUTH","pcpstate":"ME","pcpzip":"40966729","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE YARMOUTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"112 BAKER RD","madd2":"","madd3":"","mcity":"FREEPORT","mstate":"ME","mzip":"04032","pcpfaxno":2075351249,"pcpnpi":1114339611,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6WK5CD1FH92","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J309","M79645","M19032","E1159","E079","Z136","Z0000","E063","R0981","Q309","M25532","R0602","J849","I2510","J9811","Z1231","I10","J4530","J321","G4733","R053","E6689","R6889","R0789","E782","E1165","J45998","J0180","E668","J45909","R059","Z0101","M19041","E119","R790","D125","K644","K219","D509","R718","R7309","E039","H26492","R079","S022XXA","E038","D123","J189","R0600","R55","S0990XA","E875","K635","L918","L821","L299","E6609","D649","R0902","E785","H26493","H26491","M5450","I700","E669","E611","S0081XA","S161XXA","I9589","M79643","Z1152","M65331","Z780"],"date":["2025-05-13","2023-07-27","2023-07-27","2023-08-15","2023-07-13","2025-06-17","2025-06-17","2024-01-17","2025-02-18","2025-05-13","2023-07-27","2023-07-27","2023-07-27","2023-08-02","2023-07-27","2024-07-05","2023-10-18","2025-05-16","2024-11-06","2025-05-16","2024-10-18","2025-05-16","2022-12-06","2024-10-21","2023-10-18","2023-10-18","2023-08-30","2024-03-01","2024-03-01","2024-02-24","2024-10-21","2025-06-12","2023-07-28","2025-06-17","2025-06-17","2024-04-25","2024-04-25","2024-04-25","2024-04-25","2024-04-02","2024-04-02","2024-04-02","2024-07-29","2024-10-21","2022-08-16","2024-04-02","2024-04-25","2024-09-20","2023-08-02","2023-08-23","2022-07-27","2024-03-08","2024-04-25","2023-08-15","2023-08-15","2023-08-15","2024-12-18","2024-07-16","2023-08-23","2023-08-23","2023-07-12","2023-07-12","2024-10-21","2024-10-21","2024-12-18","2025-01-22","2022-07-27","2022-07-27","2023-07-25","2023-07-18","2024-02-24","2022-07-07","2022-07-01"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FLUTICASONE-VILANTEROL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","BETAMETHASONE VALERATE","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","ADVAIR HFA","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","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":""}]}]}