{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Alicia A Grace","gend":1,"currentgend":"","add":"1367 KENNEBEC RD","city":"Hampden","state":"ME","zip":"04444","dob":"1967-12-18","age":"","mstatus":"","insh":"10000076316","cliId":"","pno":2079914904,"cno":"","email":"","ename":"","eno":"","pphy":"SAUNDERS, KATHERINE ANNE","ppno":2078629400,"pcpadd":"\tEMMC Family Medicine of Hampden\t,7 Main Rd N","pcpcity":"Hampden","pcpstate":"ME","pcpzip":"04444","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE HAMPDEN","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1367 KENNEBEC RD","madd2":"","madd3":"","mcity":"Hampden","mstate":"ME","mzip":"04444","pcpfaxno":2078629411,"pcpnpi":1295161883,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9N91K48CC19","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M9902","D473","Z7982","Z87891","R1012","D693","H5213","H52223","H524","Z0101","M9901","M51361","N6489","M9903","M9904","M9900","Z1231","E119","G8929","M5137","M9905","Z0000","M5459","M47816","R1902","M797","H04123","H25011","L309","D509","M5450","G5603","M65331","M65341","G5623","Z7984","N3001","M5416","M9908","M4716","Z48811","G5601","I10","G4733","M7910","Z79899","D225","E118","M549","E611","L814","L821","L988","Z981","K660","D485","R1011","K429","L820","L538"],"date":["2025-09-23","2025-06-13","2025-06-13","2025-06-13","2022-12-16","2024-04-24","2025-04-15","2025-04-15","2025-04-15","2025-04-15","2025-07-29","2024-10-11","2025-05-21","2025-09-23","2025-09-23","2025-09-23","2025-05-15","2025-06-06","2024-08-23","2023-09-15","2024-09-24","2025-04-01","2025-06-24","2025-06-06","2022-11-08","2024-04-30","2023-04-04","2023-04-04","2024-11-04","2025-09-04","2025-03-11","2023-05-26","2023-08-17","2023-08-17","2023-05-26","2025-03-12","2025-08-26","2024-06-28","2023-01-19","2024-11-13","2023-08-30","2023-08-17","2022-12-15","2022-12-15","2023-03-15","2023-03-15","2024-10-02","2023-05-24","2023-10-17","2023-06-15","2024-10-02","2024-10-02","2024-10-02","2024-10-02","2022-12-16","2023-09-27","2022-11-10","2022-11-11","2024-10-02","2024-10-02"],"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":[["","","ACCU-CHEK AVIVA PLUS","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","ACCU-CHEK GUIDE TEST STRIP","","","Select","Select",""],["","","TIADYLT ER","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","DILTIAZEM 24HR ER","","","Select","Select",""],["","","PREDNISONE","","","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":[]}},{"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":""}]}]}