{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dale E Dunlap","gend":0,"currentgend":"","add":"85 PERRY RD","city":"EUSTIS","state":"ME","zip":"04936","dob":"1951-03-19","age":"","mstatus":"","insh":"10000087792","cliId":"","pno":2074310922,"cno":2074310922,"email":"breezy1@tdstelme.net","ename":"","eno":"","pphy":"DUROSE, GALEN G","ppno":2076955267,"pcpadd":"819 N 1ST ST,","pcpcity":"DENNISON","pcpstate":"OH","pcpzip":"44621100","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE GREENVILLE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 48","madd2":"","madd3":"","mcity":"EUSTIS","mstate":"ME","mzip":"04936","pcpfaxno":2076955234,"pcpnpi":1528059409,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6MG8U72GX42","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H34212","H52223","E119","Z961","E1165","Z794","E1151","B351","M2041","Z89411","Z89412","M79671","Z4802","Z0000","E1142","M19071","L0100","Z85828","Z872","G4733","K5730","N281","M7731","C44612","L905","R0602","R791","M79673","I509","E7800","E1122","L089","B353","H02054","H04123","H02831","L03115","I77810","D649","Z01818","R0902","L84","Z125","L918","M009","L570","L821","D485","Z1211","R2243","L820","Z452","H1032","D120","D123","H10239","M79672","M00871","E1169","M869","R7881","M00071","M1990","L03031","M7989","R262"],"date":["2024-08-28","2024-08-28","2023-02-10","2023-02-10","2025-11-09","2025-11-09","2025-03-13","2024-08-13","2023-02-10","2023-02-10","2024-05-14","2024-11-22","2025-03-20","2024-11-19","2025-06-02","2025-01-07","2025-03-06","2025-05-15","2025-05-15","2025-09-18","2024-11-21","2024-11-21","2024-11-20","2025-02-18","2025-02-18","2024-11-23","2024-11-23","2025-08-27","2024-11-21","2022-11-29","2025-05-19","2025-01-07","2025-01-30","2025-09-15","2025-09-15","2025-09-15","2024-11-20","2024-11-26","2025-05-15","2024-11-22","2024-11-22","2025-09-26","2023-11-15","2023-02-01","2024-12-06","2025-05-15","2025-01-16","2025-01-16","2023-08-28","2024-11-25","2025-08-19","2025-01-02","2023-10-05","2023-08-28","2023-08-28","2024-01-02","2025-07-23","2024-12-31","2024-12-18","2024-12-18","2024-12-18","2024-11-21","2024-11-20","2024-11-20","2024-12-19","2022-10-13"],"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":[["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","MIEBO","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","FREESTYLE LIBRE 3 SENSOR","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","ULTRA-FINE SHORT PEN NEEDLE","","","Select","Select",""],["","","NOVOLOG","","","Select","Select",""],["","","FIASP FLEXTOUCH","","","Select","Select",""],["","","TOBRAMYCIN-DEXAMETHASONE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","TOBRADEX ST","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","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":""}]}]}