{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Renita K Smith","gend":1,"currentgend":"","add":"49 HARRIMAN RD","city":"ORLAND","state":"ME","zip":"04472","dob":"1955-08-28","age":"","mstatus":"","insh":"10000078413","cliId":"","pno":2076104231,"cno":"","email":"declined@022824.com","ename":"","eno":"","pphy":"KOLISCH, ANITA D","ppno":2076647780,"pcpadd":"32 RESORT WAY,","pcpcity":"ELLSWORTH","pcpstate":"ME","pcpzip":"46051717","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"49 HARRIMAN RD","madd2":"","madd3":"","mcity":"ORLAND","mstate":"ME","mzip":"04472","pcpfaxno":2076647721,"pcpnpi":1447283981,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7YF4TW5PG60","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S62101D","J449","S62109A","J439","G8929","I10","Z720","E785","M19031","S52501A","F324","M5450","L820","Z0001","S52321A","S52571A","S52501D","L578","L218","Z87891","Z122","K2970","W19XXXA","S62101A","M5459","W010XXA","M19049","Z0000","S99912A","W108XXA","W1809XA","F17210","Z91199","S99921A","M25531","B372","R059","M5126","M5137","M47817","M4726","J432","J8410","S6291XA","K219"],"date":["2022-11-08","2024-09-26","2022-11-22","2023-04-03","2024-03-27","2023-11-03","2023-08-04","2023-08-04","2023-05-24","2022-11-22","2023-11-03","2023-11-03","2024-03-14","2024-09-26","2022-10-19","2022-10-28","2022-11-22","2024-03-14","2024-03-14","2024-09-16","2024-09-16","2023-04-21","2022-11-22","2022-10-21","2023-09-18","2022-10-19","2024-03-14","2023-02-17","2023-01-09","2023-01-09","2022-10-21","2022-10-21","2022-10-21","2023-01-09","2023-05-24","2023-06-02","2022-12-09","2023-10-19","2023-10-19","2023-10-19","2023-10-19","2023-07-11","2023-07-11","2022-11-22","2022-06-17"],"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":[["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","SPIRIVA RESPIMAT","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","NYAMYC","","","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":{"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":[]}},{"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":""}]}]}