{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ronald F Depaolo","gend":0,"currentgend":"","add":"331 WESTERN COUNTY RD","city":"PENOBSCOT","state":"ME","zip":"04476","dob":"1938-07-12","age":"","mstatus":"","insh":"10000073030","cliId":"","pno":2073269002,"cno":"","email":"rondep@myfairpoint.net","ename":"","eno":"","pphy":"Rensenbrink, Kathryn","ppno":2076647780,"pcpadd":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH,32 RESORT WAY","pcpcity":"ELLSWORTH","pcpstate":"ME","pcpzip":"04605","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"331 WESTERN COUNTY RD","madd2":"","madd3":"","mcity":"PENOBSCOT","mstate":"ME","mzip":"04476","pcpfaxno":2076647721,"pcpnpi":1124067194,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5K53FQ2HU00","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M1712","D72829","R590","H40013","H35033","H43393","H538","K5730","K760","H348320","H35032","H43812","H34822","R252","I10","C679","I480","I4811","I340","Z7901","Z79899","K922","D62","I4891","H26493","M2041","Z0000","M25562","H401131","I6523","H16012","R8289","I499","Z0189","Z8551","H348322","I081","I2720","D649","R9431","Z23","M79671","K269","Z08","H16002","H1013","H35352","H34823","K2270","Z87891","D494","N400","G4700","M25362","D509","H43813","N3289","M25462","W010XXA","Z1211","Z86010","K641","M11262","D6832","E7800","H1045","K2970","Z792","K3189","K2950","I341","R011","I4819","Z139","K319","N3020","R399","E6601","M62830","G479","Z98890","H35373"],"date":["2025-04-10","2024-07-20","2025-05-13","2024-04-16","2025-04-09","2025-05-21","2025-05-21","2024-07-19","2024-07-19","2025-03-21","2025-03-21","2025-03-21","2025-03-21","2024-06-17","2024-12-19","2024-09-09","2024-12-19","2023-09-26","2025-02-25","2024-07-29","2023-09-26","2024-07-24","2024-07-24","2024-07-24","2025-05-21","2022-11-08","2023-06-12","2023-06-21","2025-04-16","2025-05-13","2025-04-16","2024-09-09","2023-01-05","2023-02-08","2024-09-09","2023-04-14","2024-11-12","2024-11-12","2024-10-11","2023-05-03","2024-10-11","2022-11-08","2024-07-29","2023-06-01","2025-04-03","2025-04-02","2023-10-18","2023-10-18","2024-09-24","2024-10-10","2022-07-26","2024-09-09","2024-12-19","2023-06-29","2024-08-22","2023-03-09","2023-12-14","2023-06-21","2023-06-21","2023-02-03","2023-02-03","2023-02-03","2025-01-16","2024-07-20","2023-04-07","2025-04-03","2024-10-10","2022-10-11","2024-07-23","2024-09-24","2022-08-08","2022-08-08","2025-02-25","2023-02-08","2024-09-24","2022-07-26","2022-07-26","2023-06-12","2023-06-12","2023-06-12","2022-06-27","2022-06-17"],"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":[["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","BRIMONIDINE TARTRATE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LUMIGAN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","MOMETASONE FUROATE","","","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":""}]}]}