{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sallyann K Dulisse","gend":1,"currentgend":"","add":"285 DYER BAY RD","city":"STEUBEN","state":"ME","zip":"04680","dob":"1955-05-02","age":"","mstatus":"","insh":"10000077691","cliId":"","pno":2075462540,"cno":"","email":"sally.dulisee@icloud.com","ename":"","eno":"","pphy":"BEAL, JENNIFER M","ppno":2079634066,"pcpadd":"PO BOX 5,","pcpcity":"MILBRIDGE","pcpstate":"ME","pcpzip":"46580585","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE GOULDSBORO","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"285 DYER BAY RD","madd2":"","madd3":"","mcity":"STEUBEN","mstate":"ME","mzip":"04680","pcpfaxno":"","pcpnpi":1861774580,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7GE9HV0FE25","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M7602","Z5189","Z96643","R6889","S51811A","K219","Z1231","Z0000","R399","Z1239","N6002","K2100","Z01419","M7062","S51811D","Z96641","Z96642","R300","C8331","H02403","Z7185","Z124","J209","M7601","I10","E785","C8590","Z1151","K319","N951","S41111A","W228XXA","E786","L989","R059","H40013","Z98890","M25572","Z23","D2371","S1086XA","W57XXXA","N6322","D485","S59911A","S59901A","R42"],"date":["2025-04-03","2025-04-01","2024-04-15","2023-04-23","2024-05-11","2023-11-29","2025-06-30","2025-03-17","2025-03-20","2024-06-05","2024-06-05","2023-11-29","2024-03-07","2024-10-21","2024-05-13","2024-04-15","2024-04-15","2024-02-05","2024-03-14","2024-03-28","2023-10-16","2024-03-07","2025-01-03","2025-09-04","2023-03-02","2023-05-03","2023-03-02","2024-03-07","2023-11-29","2025-03-17","2024-05-11","2024-05-11","2025-06-19","2023-10-16","2025-01-03","2024-03-19","2023-10-26","2023-03-02","2023-05-03","2025-02-06","2024-10-13","2024-10-13","2023-06-27","2025-02-06","2024-05-11","2024-05-11","2022-06-16"],"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":[["","","CHOLESTYRAMINE LIGHT","","","Select","Select",""],["","","FLUBLOK TRIVALENT 2024-2025","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","PREVALITE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}