{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Craig Kesselheim","gend":0,"currentgend":"","add":"90 SEAL COVE RD","city":"SOUTHWEST HARBOR","state":"ME","zip":"04679","dob":"1954-10-02","age":"","mstatus":"","insh":"10000078417","cliId":"","pno":2072444197,"cno":2074604102,"email":"ckesselheim@gmail.com","ename":"","eno":"","pphy":"BAXTER, CLARKE W","ppno":2072445513,"pcpadd":"4760 RED BANK RD STE 104,","pcpcity":"CINCINNATI","pcpstate":"OH","pcpzip":"45227154","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 784","madd2":"","madd3":"","mcity":"SOUTHWEST HARBOR","mstate":"ME","mzip":"04679","pcpfaxno":2072445515,"pcpnpi":1487711909,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2XW7GH6WD68","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01812","Z471","Z0000","I459","Z96651","H903","D229","L814","L821","Z7189","R001","R55","L820","L538","D3131","D3132","H04123","H25093","H35363","D126","E7800","M5430","Z125","M9903","M5417","M5126","I469","M25761","Z96652","I2510","L570","R6889","B880","L989","I7121","M1711","Z23","L918","D225","L738","Z9049","R9431","I455","I7140","Z808","Z87891","J029","R1310","H9313","H9325","Z822"],"date":["2024-09-23","2025-02-12","2025-01-31","2024-10-15","2025-02-12","2025-05-06","2025-01-06","2025-01-06","2025-01-06","2025-01-06","2024-01-29","2023-12-12","2024-07-25","2024-07-25","2024-12-04","2024-12-04","2024-12-04","2024-12-04","2024-12-04","2023-01-17","2024-01-18","2023-01-17","2023-01-17","2023-07-20","2023-07-20","2023-07-20","2024-01-29","2023-06-29","2023-06-29","2024-01-29","2025-05-21","2023-07-10","2025-05-09","2024-07-22","2025-03-18","2024-10-15","2022-10-28","2024-01-02","2024-01-02","2024-01-02","2023-09-28","2023-09-28","2025-03-12","2025-03-12","2022-12-22","2025-01-24","2022-09-11","2022-09-12","2022-09-07","2022-09-07","2022-09-07"],"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":[["","","OXYCODONE HCL","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PAXLOVID (EUA)","","","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":""}]}]}