{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dawn M Hilton Hupper","gend":1,"currentgend":"","add":"52 OLD POINT AVE","city":"MADISON","state":"ME","zip":"04950","dob":"1954-01-05","age":"","mstatus":"","insh":"10000071110","cliId":"","pno":2076965395,"cno":"","email":"bobhupper@yahoo.com","ename":"","eno":"","pphy":"CLARK KELLEY, MICHAELA J","ppno":"","pcpadd":"180 KENNEDY MEMORIAL DR,SUITE 301","pcpcity":"WATERVILLE","pcpstate":"ME","pcpzip":"00000","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE DOWNTOWN WATERVILLE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"52 OLD POINT AVE","madd2":"","madd3":"","mcity":"MADISON","mstate":"ME","mzip":"04950","pcpfaxno":2078732620,"pcpnpi":1306837620,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1XH2Y32QR80","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M48061","Z1283","M62830","L570","L259","Z872","M79675","M9901","M9902","M9903","M9904","I10","R002","R21","M5450","M546","M542","M9900","I4891","D2361","I480","M9905","M9908","R519","H5203","H524","H538","Z0000","E785","L820","N281","R1310","I6522","K589","M5388","Z1231","R0789","Z789","Z79899","R600","R7401","E669","R933","Z1211","Z01818","H02833","H02836","I872","I890","Z7901","L720","H25093","H43813","R6884","N1830","R071","M79672","H02831","H02834","H53453","R6889","L03119","I129","Z832","R6330","I679","R9082","M5383"],"date":["2024-01-31","2025-06-17","2024-01-31","2023-11-13","2023-07-20","2023-11-13","2023-10-09","2025-05-16","2025-05-16","2025-05-16","2025-04-18","2025-03-05","2024-04-15","2023-01-12","2024-01-26","2024-01-26","2024-01-26","2025-05-16","2025-03-05","2024-06-10","2025-03-05","2025-04-18","2025-04-18","2024-01-25","2024-01-25","2024-01-25","2024-05-20","2024-10-04","2025-03-05","2025-06-17","2022-08-12","2024-10-25","2024-11-26","2022-09-14","2022-09-14","2023-09-06","2024-03-25","2022-09-28","2022-09-02","2022-09-02","2025-04-07","2025-03-05","2024-12-13","2023-08-27","2022-11-02","2022-11-23","2022-11-23","2022-07-14","2022-07-14","2024-11-20","2024-06-10","2024-05-20","2024-05-20","2025-05-16","2024-10-04","2024-03-25","2023-10-09","2022-11-18","2022-11-18","2022-11-18","2022-12-31","2024-06-14","2024-10-04","2024-05-02","2024-10-25","2022-07-07","2022-06-28","2022-06-16"],"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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","MULTAQ","","","Select","Select",""],["","","FLECAINIDE ACETATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","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":""}]}]}