{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"George W Russell","gend":0,"currentgend":"","add":"60 RIVERSIDE LN","city":"ELLSWORTH","state":"ME","zip":"04605","dob":"1956-07-21","age":"","mstatus":"","insh":"10000087556","cliId":"","pno":2079513580,"cno":2076643350,"email":"grussell@ohimaine.org","ename":"","eno":"","pphy":"TAGUE, COURTNEY","ppno":2078664399,"pcpadd":"EMMC Orono Family Medicine,84 Kelley Rd","pcpcity":"Orono","pcpstate":"ME","pcpzip":"04473","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"60 RIVERSIDE LN","madd2":"","madd3":"","mcity":"ELLSWORTH","mstate":"ME","mzip":"04605","pcpfaxno":2078664538,"pcpnpi":1679953194,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5C10HG0XR03","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F331","R0600","Z0101","H04123","I10","F341","Z79899","Z87891","M2550","R109","K1379","M7989","R58","Z0000","Z23","R059","H25013","H2512","H25012","L570","R0609","R42","Z122","K219","T783XXA","Z789","Z09","G5622","H2511","H25011","H26493","Z5181","M19041","H35372","L738","L578","L905","B078","R7611","Z201","R21","H26492","H26491","D122","L989","L538","W57XXXA","Z85038","K648","R600","Z4802","C44319"],"date":["2025-08-27","2025-07-11","2024-06-18","2024-06-18","2025-07-08","2024-08-30","2024-08-30","2024-11-22","2023-07-24","2024-04-08","2023-07-21","2024-07-08","2022-10-19","2024-10-14","2023-10-02","2024-08-02","2022-12-05","2023-01-18","2023-01-18","2025-01-06","2025-07-11","2025-07-11","2024-11-22","2025-07-15","2025-07-08","2025-07-08","2022-12-01","2025-09-10","2023-01-11","2023-01-11","2024-01-09","2023-06-02","2024-04-08","2022-12-16","2022-11-01","2022-11-01","2022-11-01","2022-11-01","2024-08-01","2024-08-01","2024-08-01","2024-01-18","2024-02-01","2022-12-01","2023-11-28","2024-06-17","2024-06-17","2022-12-01","2022-12-01","2025-06-28","2022-06-30","2022-06-23"],"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":[["","","DEXTROAMPHETAMINE-AMPHET ER","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DEXTROAMPHETAMINE SULFATE ER","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","METHYLPHENIDATE HCL","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ADDERALL XR","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PNEUMOVAX 23","","","Select","Select",""],["","","PRED FORTE","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","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":""}]}]}