{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Larry E Jenkins","gend":0,"currentgend":"","add":"303 MAIN ST APT 12","city":"Fort Fairfield","state":"ME","zip":"04742","dob":"1956-11-06","age":"","mstatus":"","insh":"10000089868","cliId":"","pno":2074967060,"cno":"","email":"larry_jenkins7@hotmail.com","ename":"","eno":"","pphy":"ZAHEER, HARIS","ppno":2074986151,"pcpadd":"140 ACADEMY ST,","pcpcity":"PRESQUE ISLE","pcpstate":"ME","pcpzip":"47693102","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE CARIBOU","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"303 MAIN ST APT 12","madd2":"","madd3":"","mcity":"Fort Fairfield","mstate":"ME","mzip":"04742","pcpfaxno":2074983534,"pcpnpi":1578127502,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9U76JX7DP47","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","E1165","E1159","I10","E1169","E785","G4733","Z87891","Z7189","E11649","E118","Z794","Z48810","E119","N400","R030","Z7982","H43393","H43813","H35372","Z961","H35352","H43391","R0789","H52223","R55","G4700","R0683","Z09","Z98890","Z7984","Z96642","Z0101","H35373","R3912","R9720","Z1211","H43392","K1370","Z0100","Z125","H25811","E1136","H25812","M1612","Z471","M5450","M549","M79652","M25552"],"date":["2025-09-18","2025-11-01","2024-06-24","2024-06-24","2024-02-27","2024-06-24","2024-12-31","2025-09-18","2023-04-20","2023-02-28","2023-07-19","2024-02-27","2024-09-04","2024-08-28","2024-03-20","2024-03-20","2024-03-20","2024-06-05","2024-01-25","2024-01-25","2024-01-25","2025-06-02","2024-03-27","2024-11-01","2024-09-18","2023-06-02","2024-11-19","2024-11-19","2024-11-05","2024-03-28","2023-06-08","2024-10-09","2024-02-01","2024-02-01","2023-08-18","2023-08-18","2025-10-08","2024-07-10","2025-08-07","2023-01-25","2025-04-21","2022-08-23","2022-09-06","2022-09-06","2022-08-01","2022-08-01","2022-07-27","2022-07-25","2022-06-29","2022-07-07"],"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":[["","","CITALOPRAM HBR","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","LOVASTATIN","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","PIOGLITAZONE HCL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","DEXCOM G7 RECEIVER","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","ATENOLOL-CHLORTHALIDONE","","","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":{"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":""}]}]}