{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert R Edes","gend":0,"currentgend":"","add":"666 FINSON RD LOT 174","city":"BANGOR","state":"ME","zip":"04401","dob":"1963-04-27","age":"","mstatus":"","insh":"10000071551","cliId":"","pno":2073430195,"cno":"","email":"declined@012725.com","ename":"","eno":"","pphy":"JARVIS, JAMES W","ppno":2079737979,"pcpadd":"43 WHITING HILL RD,SUITE 300","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121005","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT FAMILY MEDICINE AND RESIDENCY","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"666 FINSON RD LOT 174","madd2":"","madd3":"","mcity":"BANGOR","mstate":"ME","mzip":"04401","pcpfaxno":2079735042,"pcpnpi":1902810484,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1PV8ER5TX53","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F4321","G4733","L820","I10","Z09","S99921A","I639","I160","I161","R262","R42","R4701","I6389","Z0000","S0502XA","S9031XA","E782","Z87891","W228XXA","Y939","Y92009","F419","F32A","R4182","R350","Z711","H903","I619","Z79899","H6983","J320","J322","R531","Z8673","Z7982","R079","F331","I4710","Z20822","I493","I491","R000","E785","R059","I69351","M159","S0502XD","G459","Z125","N529","R55","I77810","I69254","Z0101","H524","H2513","S2242XA","W000XXA","Y93H1","R29898","R29810","R200","S299XXA","S2239XD","R29818","G5603","G5623","F418","Z122","W60XXXA","R1310","R6330","I69952","F1020","M150"],"date":["2023-07-05","2025-08-14","2024-09-05","2025-07-28","2025-06-26","2023-06-14","2025-05-23","2025-05-23","2025-05-22","2025-08-21","2025-08-20","2025-05-22","2025-05-23","2025-03-14","2024-09-23","2023-06-14","2023-05-26","2025-08-01","2023-06-14","2023-06-14","2023-06-14","2023-02-01","2023-04-01","2025-05-01","2025-03-21","2025-05-06","2023-05-17","2025-05-05","2025-05-05","2023-05-17","2023-05-17","2023-05-17","2025-04-16","2025-06-26","2025-06-26","2024-07-16","2022-10-10","2025-05-06","2023-02-14","2023-03-02","2023-02-14","2023-02-14","2023-03-02","2023-02-14","2024-03-21","2024-03-21","2024-09-24","2023-01-04","2025-03-21","2025-03-21","2025-08-22","2023-03-02","2025-01-24","2023-11-22","2023-11-22","2023-11-22","2024-01-20","2024-01-20","2024-01-20","2025-01-19","2025-01-19","2025-08-08","2024-01-20","2024-01-23","2025-01-20","2025-08-04","2025-08-04","2025-01-01","2025-08-01","2024-09-22","2023-01-03","2023-01-03","2025-01-24","2022-08-12","2022-08-12"],"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":[["","","SPIRONOLACTONE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","POLYMYXIN B SUL-TRIMETHOPRIM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","AMOXICILLIN","","","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":""}]}]}