{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Roger A Graves","gend":0,"currentgend":"","add":"420 Church St","city":"Brownville","state":"ME","zip":"04414","dob":"1952-04-20","age":"","mstatus":"","insh":"10000083155","cliId":"","pno":"2072791200","cno":"2079658041","email":"ragraves55@roadrunner.com","ename":"","eno":"","pphy":"Catherine M Beale","ppno":"","pcpadd":"Northern Light Primary Care Milo,135 Park St","pcpcity":"Milo","pcpstate":"ME","pcpzip":"04463","pcpcounty":"","pcpid":"","pcpname":"Northern Light Primary Care Milo","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"420 Church St","madd2":"","madd3":"","mcity":"Brownville","mstate":"ME","mzip":"04414","pcpfaxno":2079431002,"pcpnpi":1760912885,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9GD5JD7EF84","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I87311","M5451","M6281","D649","L602","L0390","E1122","N1831","N179","A4151","I70203","E1165","L97511","Z98890","Z4800","L97519","I87321","I87301","E119","Z89512","E11621","E1159","I87339","I87331","Z789","Z4801","N401","D3131","H33051","A419","R4182","E13621","Z9989","G4733","R7881","D72829","L03115","A408","I87312","E1121","E11610","I7140","Z01810","L97919","I723","Z20822","R0602","L97419","L089","R509","Z899","E1142","G453","M898X5","M2011","Z48812","I77819","I5189","Z794","G608","I87303","R609","I2720","I87333","L97411","R6521","R6520","N1830","I724","D62","I743","I130","I10","L570","I2510","M19011","M869","R0989","L97412","M25561","N250","D631","M1990","E6601","S98131A","T148XXA","E11628","S91101D","M1711","Z1211","D123","D122","D124","Z0000","T8149XA","R464","H6122","S31819S","I872","Z79899","L89322","G43109","Z961","M19071","Z0389","Z09","I129","I270","L97512","L02415","I739","A491","I6523","I87313","M25552","L603","G609","I83019","I7389","R2241","Z87891","D638","I7143","R9431","I70202","N189","M25371","M2041","R252"],"date":["2023-04-07","2025-07-24","2025-07-24","2025-04-24","2025-05-09","2023-09-27","2025-04-16","2023-10-24","2023-09-27","2023-09-24","2023-02-20","2025-04-04","2024-04-30","2025-07-16","2024-04-30","2024-05-17","2023-05-23","2023-12-05","2025-07-18","2025-07-18","2024-02-27","2025-06-29","2024-01-09","2024-03-12","2024-02-21","2024-05-17","2024-09-03","2025-05-28","2025-05-28","2023-09-24","2023-02-11","2023-02-01","2023-02-01","2025-06-17","2023-11-22","2023-07-13","2024-01-17","2023-02-11","2025-07-14","2025-04-04","2025-04-04","2024-12-04","2023-04-10","2023-09-08","2024-05-29","2023-09-24","2023-09-25","2023-05-03","2023-07-10","2023-09-24","2023-07-10","2023-05-26","2022-08-23","2023-02-20","2025-01-03","2024-05-29","2025-05-02","2025-05-02","2024-12-02","2022-10-05","2023-01-10","2023-04-10","2022-10-05","2024-01-04","2023-04-27","2023-02-21","2023-07-10","2023-06-12","2023-09-27","2023-05-10","2023-05-10","2023-05-10","2023-04-17","2024-11-29","2025-02-27","2023-02-11","2024-02-02","2023-02-11","2023-11-14","2023-12-04","2023-10-24","2023-10-24","2023-12-27","2023-12-07","2024-02-06","2024-03-12","2022-12-12","2022-12-12","2023-12-04","2025-03-05","2025-03-05","2025-03-05","2025-03-05","2023-11-28","2023-06-21","2023-06-21","2024-01-31","2023-02-16","2023-03-24","2022-10-20","2023-01-10","2022-08-23","2023-02-10","2023-09-27","2023-07-11","2023-07-07","2023-03-14","2022-08-17","2022-08-17","2023-06-21","2023-06-21","2023-06-21","2022-08-23","2023-08-31","2023-02-14","2023-11-30","2023-09-08","2023-09-08","2023-07-27","2023-09-25","2023-10-26","2023-10-26","2023-09-06","2023-02-15","2023-04-17","2022-07-22","2022-07-14","2022-07-14","2022-06-28"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","FEBUXOSTAT","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-200","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","DROPLET PEN NEEDLE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","DEXCOM G6 RECEIVER","","","Select","Select",""],["","","ULTRA-FINE NANO PEN NEEDLE","","","Select","Select",""],["","","CEFADROXIL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","FREESTYLE LIBRE 14 DAY SENSOR","","","Select","Select",""],["","","DEXCOM G6 SENSOR","","","Select","Select",""],["","","FREESTYLE LIBRE 2 SENSOR","","","Select","Select",""],["","","ULTICARE PEN NEEDLE","","","Select","Select",""],["","","ULTRA-FINE SHORT PEN NEEDLE","","","Select","Select",""],["","","INSULIN SYRINGE","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FIASP FLEXTOUCH","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","INSULIN ASPART FLEXPEN","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","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":{"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":""}]}]}