{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Danny O Damon","gend":0,"currentgend":"","add":"533 LEBANON RD","city":"WINTERPORT","state":"ME","zip":"04496","dob":"1955-04-03","age":"","mstatus":"","insh":"10000076108","cliId":"","pno":2074471665,"cno":"","email":"dannydamon@gmail.com","ename":"","eno":"","pphy":"HUNTER, KYMBERLY S","ppno":2079476141,"pcpadd":"EMMC Internal Medicine,302 Husson Ave Ste 1","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"533 LEBANON RD","madd2":"","madd3":"","mcity":"WINTERPORT","mstate":"ME","mzip":"04496","pcpfaxno":2079476720,"pcpnpi":1730732264,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6CG1PF1RF98","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z09","E119","E1142","R2689","R531","I10","Z7982","M216X2","Z0100","H40003","F03A11","G20","G609","G4752","G20C","G3183","Z0000","F515","E8352","M170","E611","R749","Z5181","D649","F02A11","F4322","B372","L602","R262","C44229","L570","D225","L814","L821","Z7189","Z125","E785","Z79899","M2142","M2141","N320","Z87442","D485","M216X1","M2011","Z7182","Z713","Z7722","M1711","D509","M4185","R790","D0462","G3184","H6123","M23203","M23200","M5450","G319","C44319","D229","L309","N211","Z23","Z98890","S83241A","N210","L720","Z7984","L728","R3915","E1140","L723","L03313","G629","I872","M11261","S30861A","M25461","M549"],"date":["2025-08-06","2025-10-15","2024-12-03","2025-08-25","2024-03-29","2024-08-28","2023-05-03","2025-05-30","2025-08-21","2025-08-21","2024-06-03","2023-09-22","2024-03-22","2025-08-25","2024-05-30","2025-08-25","2025-10-15","2023-03-09","2023-03-27","2024-09-11","2024-04-24","2024-04-24","2024-04-24","2025-10-15","2025-08-25","2024-03-04","2024-06-04","2023-11-16","2023-11-16","2024-08-08","2025-04-01","2025-04-01","2025-04-01","2025-04-01","2025-04-01","2023-11-02","2024-08-28","2024-08-28","2024-11-04","2024-11-04","2023-05-17","2023-05-17","2024-06-24","2024-01-17","2024-11-04","2023-05-03","2023-05-03","2023-05-03","2024-10-17","2024-05-10","2024-05-07","2023-03-27","2024-07-22","2023-03-09","2023-11-13","2024-09-11","2024-09-11","2024-05-07","2024-05-30","2024-08-20","2024-05-17","2024-08-20","2022-11-15","2022-10-25","2022-11-15","2022-10-27","2022-10-06","2022-10-12","2022-10-12","2022-10-12","2022-09-23","2022-08-12","2022-08-22","2022-07-28","2022-07-19","2022-07-19","2022-07-18","2022-06-25","2022-05-25","2022-05-25"],"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":[["","","CARBIDOPA-LEVODOPA","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ACCU-CHEK GUIDE TEST STRIP","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","CARBIDOPA-LEVODOPA ER","","","Select","Select",""],["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","ACCU-CHEK SOFTCLIX","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","PRAZOSIN HCL","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","RIVASTIGMINE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}