{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Becky B Gray","gend":1,"currentgend":"","add":"79 CHURCH ST","city":"DEER ISLE","state":"ME","zip":"04627","dob":"1955-02-07","age":"","mstatus":"","insh":"10000077073","cliId":"","pno":2073486143,"cno":"","email":"beckybgray@hotmail.com","ename":"","eno":"","pphy":"FUSCO, ANTHONY L","ppno":2073672311,"pcpadd":"354 Airport Rd,","pcpcity":"Stonington","pcpstate":"ME","pcpzip":"04681","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE STONINGTON","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"79 CHURCH ST","madd2":"","madd3":"","mcity":"DEER ISLE","mstate":"ME","mzip":"04627","pcpfaxno":2073672805,"pcpnpi":1396157376,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9UK7NK6KW64","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H6123","R0982","Z23","Z0100","Z1231","R6889","C641","C649","K769","D72819","K388","Z85528","L720","C181","H6122","N189","Z7183","E069","M25511","N281","R053","Q892","Z0101","L728","R590","C659","Z803","Z8052","Z8042","Z4889","E7800","Z0000","L729","Z48816","R599","Z9049","H938X9","Z780","R5382","D121"],"date":["2025-08-20","2024-08-15","2024-10-18","2025-05-16","2025-01-30","2023-05-26","2023-03-24","2025-05-06","2024-01-02","2023-05-23","2025-07-31","2025-07-31","2024-07-18","2025-07-31","2023-04-03","2024-05-07","2023-06-19","2024-05-01","2025-05-20","2025-01-08","2024-08-15","2024-11-11","2022-12-16","2024-08-15","2023-01-30","2023-06-19","2023-06-19","2023-06-19","2023-06-19","2024-12-16","2023-04-12","2024-11-26","2024-04-29","2024-11-21","2023-01-30","2023-03-21","2024-06-11","2023-01-25","2022-09-19","2022-09-19"],"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":[["","","LOVASTATIN","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","ABRYSVO","","","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":""}]}]}