{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Brent R Wilber","gend":0,"currentgend":"","add":"15 KENWOOD AVE","city":"CORINNA","state":"ME","zip":"04928","dob":"1953-09-25","age":"","mstatus":"","insh":"10000075020","cliId":"","pno":2079444878,"cno":"","email":"bwilber226@gmail.com","ename":"","eno":"","pphy":"DAY, BETHANY N","ppno":2073685747,"pcpadd":"Northern Light Health Center Newport Plaza,26 Main St Ste 2","pcpcity":"Newport","pcpstate":"ME","pcpzip":"04953","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HEALTH CENTER NEWPORT PLAZA","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 268","madd2":"","madd3":"","mcity":"CORINNA","mstate":"ME","mzip":"04928","pcpfaxno":2073685483,"pcpnpi":1023361953,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6RN3Q39QV95","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M9901","M50322","M9902","M62830","G5601","F17210","I739","I10","Z0101","L820","L570","R040","G5603","R6889","I6523","M5412","D485","G5621","L718","D225","L814","L821","Z0001","M25511","M5010","M4802","Z87891","C44329","R58","N529","L905","G5623","M9907","M65241","M47812","M542","H43392","H43811","H34211","H2513","M4722","Z7982","Z79899","Z0000"],"date":["2025-10-31","2025-10-31","2025-10-31","2025-10-31","2024-07-01","2024-07-01","2024-07-01","2024-07-01","2023-01-31","2024-12-03","2024-12-03","2023-04-06","2024-07-01","2023-01-31","2025-06-26","2025-09-26","2025-06-19","2024-10-16","2024-12-03","2024-12-03","2024-12-03","2024-12-03","2025-10-21","2025-05-29","2025-06-11","2025-07-24","2025-07-24","2025-07-10","2025-06-19","2023-03-24","2025-07-10","2024-05-14","2024-02-02","2024-02-02","2025-07-24","2025-07-24","2023-06-07","2023-06-07","2023-06-07","2023-06-07","2024-06-11","2022-09-27","2022-09-27","2022-06-29"],"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":[["","","OMEPRAZOLE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FLUOROURACIL","","","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":""}]}]}