{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Peter T Phillips","gend":0,"currentgend":"","add":"27 Stearns Farm Rd","city":"Hampden","state":"ME","zip":"04444","dob":"1948-10-27","age":"","mstatus":"","insh":"10000088148","cliId":"","pno":2076310790,"cno":"","email":"ptphillipsu2@gmail.com","ename":"","eno":"","pphy":"Clein, Annette M Hatch","ppno":2079890550,"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":"27 Stearns Farm Rd","madd2":"","madd3":"","mcity":"Hampden","mstate":"ME","mzip":"04444","pcpfaxno":2079890551,"pcpnpi":1336189109,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1KE6YK0EV78","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4730","G629","M25511","R399","R350","R32","F0394","G4739","Z0101","H5203","Z0389","M19071","F0390","F411","Z13820","M79673","T148XXA","R413","M85852","F03B0","G3184","J069","M7751","M79671","M19011","G609","R269","F419","G3185","G3109","N4829","F02A0","Z87891","R3911","Z136","S0081XA","Z0000","R059","R531","R2689","E569","G6289","S52511A","R6889","M5416","M5417","G4733","G4710","M25531","R310","G20C","G309","F0280","M4807","M5127","M4317","E785","G4731","L089","Z9181","N485","H26493","H43813","R41841","Z23","G20A1","R42","N489","H02889","M19019"],"date":["2025-03-05","2023-12-13","2025-06-03","2023-12-22","2025-05-30","2023-12-22","2024-08-26","2025-03-07","2025-01-07","2025-01-07","2025-01-07","2023-12-13","2025-04-11","2025-01-20","2025-04-07","2023-12-12","2023-12-12","2023-10-31","2025-04-07","2023-09-25","2024-01-16","2024-03-07","2024-03-12","2024-07-16","2025-01-14","2025-01-14","2025-02-04","2023-10-31","2024-12-24","2025-03-18","2025-05-15","2025-01-20","2025-01-22","2025-04-11","2023-10-27","2024-01-25","2024-09-16","2024-03-07","2024-11-07","2023-10-05","2023-10-05","2024-02-22","2024-08-02","2022-08-22","2024-02-22","2024-02-22","2024-02-09","2024-06-27","2024-08-02","2025-05-12","2024-05-02","2024-10-22","2024-10-22","2024-04-27","2024-04-27","2024-04-27","2023-09-12","2023-09-12","2024-10-30","2024-05-09","2025-05-15","2023-08-01","2023-08-01","2025-05-06","2022-09-09","2024-11-07","2024-11-06","2025-04-11","2022-07-26","2022-08-02"],"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":[["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","CARBIDOPA-LEVODOPA ER","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","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":""}]}]}