{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Claudette E Roy","gend":1,"currentgend":"","add":"119 FALLS RD","city":"Benton","state":"ME","zip":"04901","dob":"1945-01-13","age":"","mstatus":"","insh":"10000081503","cliId":"","pno":2074536367,"cno":"","email":"declined@032322.com","ename":"","eno":"","pphy":"CIANCHETTE, EMILY B","ppno":2074875154,"pcpadd":"470 SOMERSET AVE,","pcpcity":"PITTSFIELD","pcpstate":"ME","pcpzip":"49674928","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE PITTSFIELD","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"119 FALLS RD","madd2":"","madd3":"","mcity":"Benton","mstate":"ME","mzip":"04901","pcpfaxno":2074873158,"pcpnpi":1083620314,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1DN6M26XH55","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z510","Z5111","J9621","J449","U071","C3490","R935","R918","Z9221","C3432","C771","I509","I6523","Z452","J441","R911","R509","I2510","I739","I10","E7800","E6601","R590","C3492","R042","Z743","Z789","Z95828","D509","I081","Z9981","Z1152","I5032","I130","I5033","D649","C3491","F17200","Z0000","J9611","Z20822","S299XXA","R0602","J439","I110","M7989","R600","R0902","R0600","I517","R058","K551","K559","G319","Z6831","R627","E669","E039","R2243","I5030","D500","Z462","I083","T82858A","Y713","I6529","I70201","K5730","I700","G8929"],"date":["2024-10-14","2024-09-20","2024-04-24","2025-11-05","2025-11-05","2025-11-05","2024-11-20","2025-01-13","2024-11-20","2025-02-18","2024-12-18","2025-10-21","2025-02-26","2025-03-05","2025-01-10","2024-04-26","2023-08-27","2025-01-14","2025-01-14","2025-09-12","2025-01-14","2023-12-27","2023-12-10","2024-07-30","2025-07-14","2023-08-20","2025-07-14","2024-02-01","2025-04-10","2024-06-11","2024-07-02","2025-07-14","2025-10-02","2025-02-21","2025-01-11","2025-01-10","2024-05-15","2024-05-15","2025-03-18","2023-08-20","2023-08-20","2025-01-10","2025-07-14","2025-07-14","2025-01-23","2025-10-09","2025-01-11","2025-07-14","2025-01-13","2025-01-13","2023-08-20","2024-02-06","2023-05-18","2024-06-25","2025-03-18","2025-03-18","2025-03-18","2024-06-05","2025-10-09","2025-06-13","2023-07-06","2025-03-05","2024-06-11","2022-08-31","2022-08-31","2022-08-18","2022-07-27","2022-07-27","2022-07-27","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":[["","","NYSTATIN","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","EFFER-K","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","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":""}]}]}