{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Beverly A Bragdon","gend":1,"currentgend":"","add":"76 N SEARSPORT RD","city":"FRANKFORT","state":"ME","zip":"04438","dob":"1951-07-30","age":"","mstatus":"","insh":"10000088900","cliId":"","pno":2076591537,"cno":"","email":"Bevbam3@hotmail.com","ename":"","eno":"","pphy":"ASHEY, KENNI L","ppno":2078629400,"pcpadd":"43 WHITING HILL ROAD,SUITE 300","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"04412","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE HAMPDEN","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"76 N SEARSPORT RD","madd2":"","madd3":"","mcity":"FRANKFORT","mstate":"ME","mzip":"04438","pcpfaxno":"","pcpnpi":1750832911,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4PQ9FP2QA31","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z7189","L989","Z09","H40003","H6092","H2513","Z1211","J329","Z7982","Z79899","Z713","M9903","M5450","M9902","M9901","R600","H6123","E119","H608X9","T8544XA","M8589","E669","M25562","M79606","M9913","M9912","M9911","M9916","I10","K219","H938X2","K921","K649","Z1231","E785","M62838","I2510","E6601","M79673","R7309","N949","R7303","M7989","B070","R208","R238","L538","Z7689","Z853","D125","K635","K621","I700","Z13820","Z0000","H6060","H6121","H40013","H43813","H04123","N651","T8549XA","Z9012","L298","H608X3","H6122","L821","L309","K640","H5211","H5202","H524","H52203","R6889","H60502","Z923","M79604","M79605","M79671","M79672","L308","M79652","M79651","Z23","H6693","R102","H6063","N62","R635","G8929","B379","Z13220","H6120","K760","E1165","H5789","L853"],"date":["2024-10-30","2025-05-19","2024-02-26","2024-08-14","2024-11-12","2025-08-18","2024-10-28","2023-07-13","2025-03-11","2023-08-04","2024-11-25","2023-03-23","2023-03-23","2023-03-23","2023-03-23","2025-06-30","2025-06-24","2025-08-25","2025-03-31","2025-01-21","2023-12-18","2023-02-22","2025-08-26","2025-10-31","2024-10-15","2024-10-15","2024-10-15","2024-08-19","2025-08-25","2025-08-25","2025-03-31","2025-04-03","2025-03-31","2025-03-06","2025-02-24","2025-10-24","2024-03-04","2024-04-20","2025-05-30","2023-11-16","2023-11-16","2024-08-05","2025-06-30","2024-12-04","2024-12-04","2024-12-04","2024-12-04","2024-03-08","2025-01-21","2024-10-28","2024-10-28","2024-10-28","2023-08-04","2023-12-18","2025-02-17","2025-09-23","2025-09-23","2025-08-18","2025-02-14","2025-08-18","2024-10-15","2024-04-08","2025-01-21","2023-08-08","2024-06-03","2024-01-29","2025-01-07","2024-10-25","2024-10-28","2025-02-20","2025-02-20","2025-02-20","2025-02-20","2023-05-30","2023-06-30","2025-01-21","2025-05-30","2025-05-30","2025-05-30","2025-05-30","2023-02-06","2025-10-24","2025-10-24","2025-10-24","2025-03-11","2023-08-10","2025-06-24","2024-10-15","2024-08-05","2025-08-25","2023-08-10","2023-03-09","2022-10-03","2022-10-18","2022-09-27","2022-07-25","2022-05-16"],"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":[["","","FREESTYLE LITE TEST STRIP","","","Select","Select",""],["","","MODERNA 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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":{"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":""}]}]}