{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sabrina G Warner","gend":1,"currentgend":"","add":"264 CUSHMAN RD","city":"WINSLOW","state":"ME","zip":"04901","dob":"1955-12-31","age":"","mstatus":"","insh":"10000080894","cliId":"","pno":2078553047,"cno":2078553047,"email":"sabrinaw@maine.rr.com","ename":"","eno":"","pphy":"NEWCOMBE, JODI A","ppno":2075351200,"pcpadd":"385 ROUTE 1,","pcpcity":"YARMOUTH","pcpstate":"ME","pcpzip":"40966729","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE YARMOUTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"264 CUSHMAN RD","madd2":"","madd3":"","mcity":"WINSLOW","mstate":"ME","mzip":"04901","pcpfaxno":2075351249,"pcpnpi":1114339611,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6D39JX3JC43","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N952","M25562","R200","J189","Z7982","D72829","R002","G459","H00011","R509","R7401","J069","R300","R10A1","M5481","Z23","M25511","Z1231","N3941","R350","D492","L308","D229","Z4509","Z0001","I088","I4710","R918","R0989","R0602","R059","R5383","M25552","M2550","R0600","N390","Z09","J90","S2243XA","M85852","R309","I2510","S2249XA","R079","S4991XD","J9600","Z9981","Z0000","E1165","Z7984","E782","M25569","M6281","Z1211","K621","K5730","I10","N760","I081","J918","M8448XA","E119","I6522","Z0101","M85859","Z780","J029","R0982","M19011","R779","J209","D0439","R202","R410","G319","L292","L570","R062","I4891","D128","N898","L719","L578","D1801","Z85828","L814","M19071","M7731","M79671","M85871","E6601","R7303","S2239XA","X58XXXA","D126","M8580","L409","Z6833","K760","R7989","E785","J9601","R0781","S4991XA","S2242XD","S2241XD","Z13820","M5134","M47814","S2231XD","R6889","R0789","K644","R21","E11628"],"date":["2023-07-13","2025-08-28","2025-05-31","2023-05-19","2023-07-13","2023-04-28","2025-07-07","2025-07-18","2024-03-08","2023-04-27","2023-04-27","2023-04-27","2025-07-22","2025-10-28","2025-10-28","2025-10-28","2025-01-16","2025-04-15","2025-07-22","2025-07-22","2024-02-29","2024-02-29","2025-03-06","2025-10-17","2025-03-26","2025-07-07","2025-07-07","2023-05-03","2023-05-03","2023-11-10","2024-04-30","2025-06-04","2025-06-04","2025-06-04","2023-11-10","2024-04-12","2023-11-20","2023-05-06","2023-05-06","2023-09-18","2023-06-30","2023-05-03","2023-05-03","2023-11-10","2025-05-01","2023-05-03","2023-05-03","2025-03-06","2024-03-20","2024-03-20","2024-10-30","2025-10-02","2025-10-02","2025-04-17","2025-04-17","2025-04-17","2025-07-07","2023-07-06","2024-12-12","2023-05-05","2023-05-05","2024-01-05","2025-05-31","2025-10-14","2025-04-14","2025-04-14","2023-04-19","2023-04-19","2025-01-16","2025-03-20","2024-05-03","2024-03-12","2025-05-31","2025-05-31","2025-05-31","2024-10-03","2023-02-16","2023-04-27","2025-07-18","2025-04-17","2024-10-03","2023-02-16","2023-02-16","2025-03-06","2025-03-06","2025-03-06","2023-03-07","2023-03-07","2023-03-07","2023-03-07","2024-10-30","2023-03-07","2023-05-19","2023-05-19","2025-05-09","2023-10-02","2023-10-02","2023-03-07","2023-06-20","2023-06-20","2023-11-10","2023-05-03","2023-05-03","2025-01-22","2023-06-20","2023-06-20","2025-04-14","2025-11-07","2025-11-07","2025-11-07","2023-03-13","2025-01-22","2022-09-29","2022-09-29","2022-09-15"],"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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","DILTIAZEM 12HR ER","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","IPRATROPIUM BROMIDE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","VASCEPA","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","OMEGA-3 ACID ETHYL ESTERS","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","MODERNA COVID (12Y UP)VAC(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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}