{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Linda D Moulton","gend":1,"currentgend":"","add":"131 SILVERS MILLS RD","city":"DEXTER","state":"ME","zip":"04930","dob":"1947-08-13","age":"","mstatus":"","insh":"10000077256","cliId":"","pno":2079246926,"cno":"","email":"bettyjomoulton@yahoo.com","ename":"","eno":"","pphy":"ROOPE, SHELLY L","ppno":2078764811,"pcpadd":"22 HALEY CT,","pcpcity":"SANGERVILLE","pcpstate":"ME","pcpzip":"44793000","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE SANGERVILLE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"131 SILVERS MILLS RD","madd2":"","madd3":"","mcity":"DEXTER","mstate":"ME","mzip":"04930","pcpfaxno":2078764302,"pcpnpi":1487021259,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7EF0A39YF17","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0001","H353222","H353213","H43813","H2513","Z739","I10","R42","Z79899","M1711","M47817","E559","M419","M5450","R410","S0990XA","M25561","R079","K449","R9389","M546","H905","Z0000","R5383","R300"],"date":["2025-08-29","2024-07-09","2023-08-07","2023-08-07","2023-08-07","2025-03-01","2025-02-12","2025-04-08","2023-10-06","2025-08-22","2024-11-12","2023-03-29","2024-05-17","2023-04-17","2025-05-12","2025-05-12","2023-03-03","2023-03-03","2023-03-03","2023-03-03","2023-01-25","2024-05-14","2022-11-01","2022-11-01","2022-06-14"],"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":[["","","BACLOFEN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","VEOZAH","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","VRAYLAR","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","FENTANYL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","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":""}]}]}