{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rosemary D Bender","gend":1,"currentgend":"","add":"320 ROGERS POINT RD","city":"STEUBEN","state":"ME","zip":"04680","dob":"1952-08-05","age":"","mstatus":"","insh":"10000080362","cliId":"","pno":2075985585,"cno":"","email":"rbender52@outlook.com","ename":"","eno":"","pphy":"HIGGINS, MARTIN","ppno":"","pcpadd":"Northern Light Primary Care,","pcpcity":"Ellsworth","pcpstate":"ME","pcpzip":"04605","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"320 ROGERS POINT RD","madd2":"","madd3":"","mcity":"STEUBEN","mstate":"ME","mzip":"04680","pcpfaxno":"","pcpnpi":1851917751,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7TN7DA5NJ65","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E039","J432","D500","L816","D649","Z122","H43811","Z0100","R0789","R002","Z48810","H35342","H59032","Z87891","R9389","J9811","I4710","F419","H35372","Z961","I10","E785","K319","K621","I471","I2510","Z955","Z7982","Z0389","Z13820","R109","R195","Z1231","I493","R9431","Z98890","J984","M542","M85852","D509","J449","R1084","Z0000","H5315","M50322","M47812","M4312","E782","Z0130","H26491","H40051","H3561","R450","K5730","K760","N838","N281","Z1159","J439","M9900","M9901","M9902","M9907","F4323"],"date":["2025-08-29","2024-08-24","2024-07-23","2025-08-29","2024-07-29","2024-06-26","2024-04-11","2024-02-19","2023-03-06","2023-03-30","2025-06-17","2025-06-17","2025-06-17","2025-06-17","2024-07-30","2024-07-30","2023-12-01","2023-12-01","2025-03-26","2025-03-26","2025-03-26","2023-06-01","2024-07-22","2024-07-22","2023-05-01","2024-11-17","2023-05-01","2023-05-01","2025-08-07","2025-08-07","2024-07-23","2024-07-23","2025-08-07","2023-04-10","2023-03-31","2024-08-01","2024-07-30","2025-05-29","2022-12-08","2024-10-11","2024-09-16","2024-07-21","2024-10-11","2025-09-10","2025-04-29","2025-04-29","2025-04-29","2024-06-07","2024-07-01","2024-03-12","2024-03-06","2024-03-05","2023-04-28","2024-07-21","2024-07-21","2024-07-21","2024-07-21","2023-10-06","2024-09-16","2025-05-29","2025-05-29","2025-05-29","2025-05-29","2022-06-23"],"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":[["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","DORZOLAMIDE-TIMOLOL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ARNUITY ELLIPTA","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","ADVAIR HFA","","","Select","Select",""],["","","FLOVENT DISKUS","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","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":""}]}]}