{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Stacy G Waitt","gend":1,"currentgend":"","add":"14 ASPEN WAY","city":"BREWER","state":"ME","zip":"04412","dob":"1956-05-31","age":"","mstatus":"","insh":"10000087239","cliId":"","pno":2079896556,"cno":2073071383,"email":"Stacywaitt62@gmail.com","ename":"","eno":"","pphy":"JOHNSTON, PAULINE K","ppno":"","pcpadd":"43 WHITING HILL RD STE 300,","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121006","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"14 ASPEN WAY","madd2":"","madd3":"","mcity":"BREWER","mstate":"ME","mzip":"04412","pcpfaxno":2079735042,"pcpnpi":1598705360,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3PP0R81DY20","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25511","M25562","M542","M5412","E785","M75121","M4802","H353132","S46011A","R42","I6381","Z4789","Z0101","H2513","Z1231","Z0001","M1711","Z1151","Z01419","Z124","Q839","Z780","M810","Z885","Z87891","D2272","M1712","R6889","M170","M65252","M19011","M25561","G2581","M19012","R200","M5021","M47812","M4312","R5383","R7301","M25461","I63231","I639","Z0000","L570","D225","L821","L814","L738","D485","G5601","G5621","N6452","S83232A","M5030","Z23","R7303","M75101","Z09","L989","R202","Z98890","R930","I6782","Z8673","Z79899","Z7982"],"date":["2025-01-30","2024-10-17","2024-10-11","2024-10-11","2025-05-19","2024-09-05","2024-10-18","2025-10-20","2025-01-30","2025-01-28","2024-11-04","2024-10-14","2025-04-30","2023-12-05","2025-09-05","2025-05-05","2025-06-30","2024-04-01","2024-04-01","2024-04-01","2025-09-10","2025-09-05","2025-09-05","2023-06-05","2023-06-05","2025-02-03","2024-04-09","2023-04-20","2024-04-09","2024-04-09","2024-08-21","2024-09-20","2023-03-29","2024-05-17","2024-05-17","2024-08-10","2024-08-10","2024-08-10","2025-05-19","2025-05-19","2025-05-30","2024-10-30","2024-10-30","2023-03-28","2025-02-03","2025-02-03","2025-02-03","2025-02-03","2025-02-03","2025-02-03","2024-07-11","2024-07-11","2025-09-10","2024-11-18","2024-05-23","2023-03-28","2025-11-10","2024-08-21","2025-01-15","2024-07-01","2024-05-23","2025-01-15","2024-10-30","2024-08-17","2024-08-19","2024-08-19","2024-08-19"],"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":[["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","PRAMIPEXOLE DIHYDROCHLORIDE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}