{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Willard Stone","gend":0,"currentgend":"","add":"208 ELM ST","city":"MILO","state":"ME","zip":"04463","dob":"1949-09-23","age":"","mstatus":"","insh":"10000075810","cliId":"","pno":2077172328,"cno":"","email":"Willstone49@icloud.com","ename":"","eno":"","pphy":"SHEPARD, NATHAN D","ppno":2075644464,"pcpadd":"Northern Light Primary Care Dover Foxcroft,891 W Main St Ste 200","pcpcity":"Dover Foxcroft","pcpstate":"ME","pcpzip":"04426","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE DOVER FOXCROFT","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 53","madd2":"","madd3":"","mcity":"MILO","mstate":"ME","mzip":"04463","pcpfaxno":2075644461,"pcpnpi":1972778892,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9QG8GV2KU49","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B351","C9200","M9903","L600","R053","D45","Z7969","Z5111","J209","S79911A","R059","M19071","M79621","B078","Z789","R208","L538","L700","H401131","L719","H16223","H04123","Z5321","E871","Z0001","E222","C92Z0","R928","N644","U071","L03039","R1030","K8020","N400","K4020","K819","K5900","R1031","L298","C9201","H527","Z7902","Z79899","Z0000","L0291","R001","M25571","Z7960","R509","L03031","D649","J8410","D471","H6123","I10","Z809","H00011","B3789","L720","D61818","S20469A","D7589","R058","T7849XA","L299","L723","L7211"],"date":["2025-09-11","2025-09-08","2023-12-21","2024-11-07","2024-04-16","2025-08-04","2025-08-04","2025-08-04","2024-03-04","2022-11-26","2024-02-19","2024-10-04","2023-08-07","2023-06-15","2023-06-15","2023-06-15","2023-06-15","2023-06-15","2025-04-28","2025-04-28","2025-04-28","2025-04-28","2025-03-18","2024-10-14","2025-06-09","2024-10-14","2024-08-20","2023-05-01","2023-05-01","2025-01-02","2024-09-17","2024-10-13","2024-10-13","2024-10-13","2024-10-13","2024-10-14","2024-10-14","2025-03-12","2024-01-18","2024-11-15","2025-04-28","2025-02-17","2025-02-17","2024-05-06","2024-05-29","2025-08-18","2024-10-04","2024-08-26","2025-01-02","2025-06-19","2024-03-22","2024-04-09","2024-10-25","2023-05-24","2024-12-03","2024-11-25","2024-01-04","2025-08-25","2024-06-10","2025-08-22","2025-07-18","2024-08-07","2024-03-21","2022-08-12","2022-08-30","2022-09-06","2022-08-02"],"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":[["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","GENTAMICIN SULFATE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","LINEZOLID","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","POSACONAZOLE","","","Select","Select",""],["","","VENCLEXTA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","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":""}]}]}