{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert P Beaulieu","gend":0,"currentgend":"","add":"40 STATION ST","city":"ASHLAND","state":"ME","zip":"04732","dob":"1953-01-19","age":"","mstatus":"","insh":"10000088689","cliId":"","pno":2075515871,"cno":"","email":"","ename":"","eno":"","pphy":"MACHARIA, THOMAS C","ppno":2077643142,"pcpadd":"146 ACADEMY ST,","pcpcity":"PRESQUE ISLE","pcpstate":"ME","pcpzip":"47693102","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE PRESQUE ISLE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 14","madd2":"","madd3":"","mcity":"ASHLAND","mstate":"ME","mzip":"04732","pcpfaxno":2077608170,"pcpnpi":1881853919,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3N07KT1HG44","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H40013","B079","H25813","H04123","Z48810","E782","Z0000","G4733","I10","Z87891","H25811","E785","E6601","Z1211","K644","K5730","D751","N401","Z79899","Z0001","H25812","Z98890","Z4802","D485","Z961","D2339","H6123","H353131","Z01810","H269","Z9989","Z23","H43813"],"date":["2025-03-18","2024-09-13","2025-03-18","2025-03-18","2025-06-19","2025-05-28","2024-05-22","2025-01-13","2025-05-28","2025-02-03","2025-04-09","2024-05-22","2024-05-22","2025-02-03","2025-02-03","2025-02-03","2023-06-01","2025-05-28","2025-05-28","2025-05-28","2025-04-30","2023-03-14","2023-09-15","2023-09-06","2025-06-23","2023-09-06","2025-07-21","2025-03-18","2025-03-23","2025-03-23","2023-01-12","2022-11-18","2022-08-22"],"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":[["","","OMEPRAZOLE","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","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":{"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":[]}},{"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":""}]}]}