{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kevin D O Connor","gend":0,"currentgend":"","add":"24 SKILLIN RD","city":"CUMBERLAND CENTER","state":"ME","zip":"04021","dob":"1956-04-10","age":"","mstatus":"","insh":"10000084644","cliId":"","pno":2073910733,"cno":"","email":"grandpa041956@gmail.com","ename":"","eno":"","pphy":"Merson, Daniel M","ppno":2075351200,"pcpadd":"YARMOUTH PRIMARY CARE,385 RTE 1","pcpcity":"YARMOUTH","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE YARMOUTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"24 SKILLIN RD","madd2":"","madd3":"","mcity":"CUMBERLAND CENTER","mstate":"ME","mzip":"04021","pcpfaxno":2075351249,"pcpnpi":1982652129,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9XW9XM7MF59","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F321","K7581","E109","H2513","H31001","N401","J069","T7849XA","I4430","N200","N281","I10","E782","I442","Z950","Z45018","E1165","R079","R0602","M5450","Z87448","E1142","M25561","K8020","R310","K219","U071","G4733","Z794","I77819","M549","K760","R109","K5730","Z9049","K625","R0683","I7090","R519","L309","Z7984","I77810","M48061","M47816","R071","J320","Z86010","Z800","E669","N390","J4531","Z20822","R059","E11649","R042","K8010","R221","M6281","R42","R2689","R5381","D696","R197","R6889","Z23","Z87891","Z0000"],"date":["2025-06-11","2024-11-12","2024-09-30","2024-09-30","2023-09-08","2023-09-11","2023-06-16","2023-06-16","2024-08-12","2025-06-16","2024-06-17","2024-11-12","2024-11-12","2023-02-02","2024-03-18","2025-05-12","2024-11-18","2023-02-10","2023-01-30","2023-01-30","2023-01-30","2024-09-23","2024-09-23","2023-05-22","2025-01-16","2023-12-04","2023-12-12","2025-06-14","2023-10-30","2023-01-31","2023-01-31","2023-05-22","2023-01-31","2023-07-14","2023-07-14","2023-10-30","2023-10-30","2023-02-03","2024-03-18","2024-03-18","2023-10-30","2024-08-26","2023-01-30","2023-01-30","2023-01-30","2023-11-16","2024-07-30","2024-07-30","2024-09-25","2023-07-03","2025-04-30","2023-06-26","2023-06-26","2023-02-01","2022-10-04","2023-05-22","2023-05-08","2024-12-19","2024-12-19","2024-12-19","2024-12-19","2023-12-04","2024-02-01","2023-11-01","2022-11-28","2023-05-22","2024-11-26"],"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":[["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","LANSOPRAZOLE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","INSULIN ASPART FLEXPEN","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-200","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","FLUTICASONE-VILANTEROL","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-100","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","ULTRA-FINE NANO PEN NEEDLE","","","Select","Select",""],["","","UNIFINE PENTIPS","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","DEXCOM G6 SENSOR","","","Select","Select",""],["","","DEXCOM G6 TRANSMITTER","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CEFDINIR","","","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":""}]}]}