{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Leo D Roy","gend":0,"currentgend":"","add":"20 MILES HILL RD.","city":"BURNHAM","state":"ME","zip":"04922","dob":"1948-06-03","age":"","mstatus":"","insh":"10000072131","cliId":"","pno":2077166777,"cno":2077166777,"email":"cackleburn@yahoo.com","ename":"","eno":"","pphy":"BADEEN, STEVEN J","ppno":2073684292,"pcpadd":"100 Main St,","pcpcity":"Newport","pcpstate":"ME","pcpzip":"04953","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE NEWPORT","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"20 MILES HILL RD.","madd2":"","madd3":"","mcity":"BURNHAM","mstate":"ME","mzip":"04922","pcpfaxno":2079735042,"pcpnpi":1801984471,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3TH3U08EQ87","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I428","I10","Z87891","E782","I429","I129","K2090","K2270","H02831","H02834","Z8673","Z7982","Z79899","S0990XA","D509","R1310","I6381","D500","Z1211","D125","H33321","N200","N209","R319","S0003XA","K648","K2970","R221","I5189","E785","N1831","R809","E7800","Z87448","Z87442","R109","N132","K4090","N1830","D649","Z122","H538","Z0001","N138","N50819","N189","K5900","N201","R350","R3915","H33329","H524","Z0100","R6889","R4189","N400","Z720","D72829","F17210","R42","M9904","M9903","M62830","M9902","H5202","R7303","I6523","I6782","H53129","K219","R112","G453","R7301","R519"],"date":["2025-10-15","2025-10-01","2025-05-28","2023-04-25","2023-01-09","2025-05-28","2025-10-28","2025-10-28","2024-04-22","2024-04-22","2024-04-09","2024-04-22","2024-05-13","2023-01-12","2024-05-13","2023-05-31","2023-05-31","2024-04-10","2023-09-11","2023-09-11","2024-11-20","2024-09-16","2024-05-13","2024-05-13","2023-01-12","2023-09-11","2025-10-28","2023-10-24","2023-01-09","2023-01-09","2025-10-03","2025-05-28","2023-09-27","2023-08-07","2024-11-18","2024-02-05","2024-03-26","2024-03-26","2024-05-29","2024-04-10","2025-04-14","2024-04-22","2023-02-28","2024-04-10","2024-03-20","2024-07-31","2024-02-05","2024-05-28","2024-05-28","2024-05-28","2023-11-16","2023-11-16","2023-11-16","2023-12-27","2023-02-28","2023-02-28","2023-04-11","2024-04-10","2025-04-14","2023-04-25","2025-09-08","2025-09-08","2025-09-08","2025-09-08","2024-11-20","2025-10-13","2022-09-22","2022-09-13","2022-09-13","2022-08-25","2022-08-24","2022-08-26","2022-08-26","2022-08-24"],"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":[["","","CARVEDILOL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","CALCITRIOL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","LOVASTATIN","","","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":""}]}]}