{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Richard Libby","gend":0,"currentgend":"","add":"187 LEBANON RD","city":"WINTERPORT","state":"ME","zip":"04496","dob":"1955-05-09","age":"","mstatus":"","insh":"10000082185","cliId":"","pno":2072230013,"cno":"","email":"bfd7224752lib@roadrunner.com","ename":"","eno":"","pphy":"STEPHENS, JOHN W","ppno":2078629400,"pcpadd":"EMMC Family Medicine of Hampden,\t7 Main Rd N","pcpcity":"Hampden","pcpstate":"ME","pcpzip":"04444","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE HAMPDEN","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 351","madd2":"","madd3":"","mcity":"WINTERPORT","mstate":"ME","mzip":"04496","pcpfaxno":2078629411,"pcpnpi":1104834837,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1P66TC8QE50","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E109","I10","E039","E785","Z79899","Z0000","E103299","J342","H905","H908","S8392XA","Z0110","S51011A","E1110","Z125","M25562","Z0101","E119","H52223","H40053","H9192","R001","Z743","W19XXXA","R4182","R42","Z7982","E1065","E113293","Z950","M1712","I442","M1990","R739","I959","R0902","E1010","H9072","E1165","H90A21","K5900","D519","E1022","Z45018","H748X3","H90A32","H6692","Z4589","R5383","M549","Z792","Z23","Z794"],"date":["2025-05-27","2025-08-06","2025-05-27","2025-05-19","2025-04-01","2025-02-18","2025-09-17","2024-04-09","2024-04-09","2024-09-25","2023-02-09","2023-08-21","2025-08-06","2025-09-09","2023-08-21","2023-05-10","2025-05-20","2025-08-11","2025-05-20","2024-11-19","2023-06-21","2025-07-18","2025-09-01","2025-09-01","2025-09-21","2025-08-22","2023-06-21","2025-09-17","2025-05-20","2025-07-29","2023-02-09","2025-08-19","2023-02-09","2025-09-01","2025-09-01","2025-09-21","2025-09-01","2024-08-30","2025-01-16","2024-07-05","2025-08-12","2025-08-05","2025-08-21","2025-08-11","2024-06-26","2024-06-26","2024-09-25","2024-09-25","2025-10-02","2022-11-03","2022-11-03","2022-07-18","2022-07-18"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","TRESIBA","","","Select","Select",""],["","","NANO PEN NEEDLE","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","NOVOLOG","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","UNILET LANCETS","","","Select","Select",""],["","","GLUCOCARD EXPRESSION","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-100","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","ULTRA-FINE NANO PEN NEEDLE","","","Select","Select",""],["","","SHINGRIX","","","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":{"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":""}]}]}