{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy W Glidden","gend":1,"currentgend":"","add":"29 BRUCE RD","city":"CORINTH","state":"ME","zip":"04427","dob":"1955-02-16","age":"","mstatus":"","insh":"10000086844","cliId":"","pno":2075300637,"cno":"","email":"nglidden99@yaho.com","ename":"","eno":"","pphy":"YOUNG, AMANDA M","ppno":2079437752,"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":"29 BRUCE RD","madd2":"","madd3":"","mcity":"CORINTH","mstate":"ME","mzip":"04427","pcpfaxno":2079431002,"pcpnpi":1578791760,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6WQ9RC8YX58","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25562","F411","F320","E039","R32","Z1231","Z780","M85852","N3946","M170","R399","Z0000","H26493","H04123","H43813","L608","Z13820","Z0101","H5203","N390","R300","H26492","Z9682","R8290","H02831","H02834","H02402","R519","H524","N3281","Z0001","H8110","N1830","B351","N182","Z8614","K5900","F330","R3129","Z48816","L600","N393","E119","H8111","M159","E6601","Z01818","R7303"],"date":["2025-05-20","2025-05-08","2025-11-12","2025-04-14","2025-10-22","2025-11-07","2025-11-07","2025-11-07","2025-05-13","2025-07-22","2024-10-02","2025-09-29","2023-05-15","2024-01-31","2025-10-02","2024-04-30","2025-11-07","2025-10-02","2022-11-30","2024-01-15","2025-10-22","2023-02-02","2025-02-06","2023-11-22","2024-01-31","2024-01-31","2024-02-13","2023-10-19","2025-10-02","2024-08-21","2025-10-13","2023-06-27","2023-05-17","2023-12-05","2023-04-05","2023-04-05","2023-04-05","2024-04-10","2025-10-22","2024-08-13","2024-09-09","2025-10-22","2023-11-29","2023-06-28","2024-04-29","2024-04-29","2024-07-23","2022-11-07"],"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":[["","","FAMOTIDINE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","TERBINAFINE HCL","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE ER","","","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":""}]}]}