{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Anita M Raymond","gend":1,"currentgend":"","add":"167 EASTBROOK RD","city":"Franklin","state":"ME","zip":"04634","dob":"1956-08-02","age":"","mstatus":"","insh":"10000087899","cliId":"","pno":2075652387,"cno":2074796244,"email":"OPTOUT@10182023.COM","ename":"","eno":"","pphy":"CROWLEY, KERRY W","ppno":2079634066,"pcpadd":"50 UNION ST,ELEANOR WIDENER DIXON MEMORIAL CLINIC","pcpcity":"ELLSWORTH","pcpstate":"ME","pcpzip":"46051586","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE GOULDSBORO","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"167 EASTBROOK RD","madd2":"","madd3":"","mcity":"Franklin","mstate":"ME","mzip":"04634","pcpfaxno":2079637723,"pcpnpi":1679511075,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8Q56MD7PX42","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0100","H401231","Z48815","R079","R140","Z8669","M79604","M810","K4090","J069","Z1152","J40","J329","L0390","E785","I4710","K219","Z23","N760","N390","Z1231","M5410","R2231","M48061","L539","R911","R002","N8110","Z0000","Z87891","S40029A","S73191A","S76312A","X58XXXA","M1611","Z01419","N819","Z4689","R6889","L03113","M6688","M67853","Z122","M5450","Z1151","Z124","D1730","I471","R609","Z7189","Z1239","Z1211","R600","R7989","R001","Z79899","M5117","M4727","M4316","K5730","M7989","M92219","M5116","M4726","M4317","R300","R1030","R350","A6920","R9431"],"date":["2024-10-08","2025-06-18","2023-03-06","2023-11-21","2023-03-21","2022-11-07","2022-10-24","2025-06-12","2023-02-14","2024-02-04","2024-02-04","2025-04-15","2025-04-15","2025-07-14","2024-01-11","2024-11-14","2023-10-18","2024-10-09","2024-10-03","2024-10-03","2025-05-28","2022-11-28","2025-07-21","2024-12-10","2025-07-19","2025-07-16","2022-12-28","2022-12-28","2025-02-10","2025-07-16","2025-06-19","2024-11-13","2024-11-13","2024-11-13","2024-10-05","2024-01-08","2024-01-08","2024-01-08","2023-07-03","2025-07-24","2024-10-05","2024-10-05","2024-03-29","2024-12-10","2024-01-08","2024-01-08","2023-02-14","2023-02-14","2025-07-19","2025-01-31","2025-01-31","2025-01-31","2025-07-19","2025-07-19","2023-10-26","2022-10-26","2024-11-27","2024-11-27","2024-11-27","2023-03-21","2025-07-21","2022-09-29","2022-09-29","2022-09-29","2022-09-29","2022-08-19","2022-08-19","2022-08-19","2022-07-25","2022-06-24"],"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":[["","","LATANOPROST","","","Select","Select",""],["","","ENOXAPARIN SODIUM","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","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":""}]}]}