{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Judy A Jewell","gend":1,"currentgend":"","add":"20 JEWELL DR","city":"HAMPDEN","state":"ME","zip":"04444","dob":"1950-05-06","age":"","mstatus":"","insh":"10000075158","cliId":"","pno":2074787830,"cno":"","email":"","ename":"","eno":"","pphy":"ASHEY, KENNI L","ppno":2078629400,"pcpadd":"43 WHITING HILL ROAD,SUITE 300","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"04412","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE HAMPDEN","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"20 JEWELL DR","madd2":"","madd3":"","mcity":"HAMPDEN","mstate":"ME","mzip":"04444","pcpfaxno":"","pcpnpi":1750832911,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5GD3RT9QJ60","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4891","Z7901","R079","Z4509","R918","C3411","Z8679","R0602","Z1231","C3490","I480","N8110","I10","F419","Z0000","Z23","L918","R55","Z13820","Z1272","R911","C3491","J939","M25561","M25562","Z96659","I4819","Z48812","Z4682","H16143","H5203","H52223","H524","G4700","Z79899","Z124","M792","N952","Z79890","N8111","R221","Z48813","N3090","R0789","Z09","Z0101","Z902","Z0001","J90","R059","L820","L538","D225","L814","L821","R6889","Z85118","Z483","R42","Z1329","Z13220","E785","E669","M25661","M25662","Z96653","I083","R197","R7309","M85851","M85852","I081","R635","L989","F411","R5383","Z131"],"date":["2025-06-17","2025-01-03","2024-12-27","2025-08-07","2024-10-10","2025-08-04","2024-12-27","2024-12-27","2025-03-18","2025-09-05","2025-08-27","2025-03-31","2025-07-18","2025-07-18","2023-09-21","2023-09-21","2025-08-25","2024-09-13","2024-02-15","2025-01-29","2024-09-13","2025-02-06","2024-10-31","2023-11-08","2023-11-08","2023-11-08","2025-01-23","2024-11-01","2024-11-01","2025-06-05","2025-06-05","2025-06-05","2025-06-05","2025-07-18","2025-07-18","2025-01-29","2024-12-23","2025-01-29","2025-01-29","2025-01-29","2023-10-31","2024-11-06","2023-10-31","2024-12-27","2024-05-29","2024-09-30","2025-01-03","2025-06-17","2024-12-16","2024-12-16","2024-08-22","2024-08-22","2025-08-25","2025-08-25","2025-08-25","2023-09-25","2025-09-05","2024-11-19","2024-11-06","2023-10-02","2023-10-02","2022-12-05","2022-12-05","2023-08-03","2023-08-03","2023-08-03","2024-11-26","2025-02-11","2022-11-18","2024-02-15","2024-02-15","2023-12-19","2022-09-07","2022-09-07","2022-09-07","2022-09-08","2022-09-08"],"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":[["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","MULTAQ","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","TAGRISSO","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","SHINGRIX","","","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":""}]}]}