{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mary B Coffin","gend":1,"currentgend":"","add":"58 PARKHURST SIDING RD","city":"PRESQUE ISLE","state":"ME","zip":"04769","dob":"1956-12-30","age":"","mstatus":"","insh":"10000089905","cliId":"","pno":2075515568,"cno":"","email":"mary_coffin@msn.com","ename":"","eno":"","pphy":"MCFADGEN, ROBERT L","ppno":2077643142,"pcpadd":"TAMC Family Practice and Internal Medicine,23 North St Ste 4","pcpcity":"Presque Isle","pcpstate":"ME","pcpzip":"04769","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 45","madd2":"","madd3":"","mcity":"PRESQUE ISLE","mstate":"ME","mzip":"04769","pcpfaxno":2077608170,"pcpnpi":1689025959,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5F13F44ED72","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M329","D696","Z79899","D619","D704","R768","Z950","D485","M2550","H35363","H25813","D3132","D759","D595","R55","Z87891","D6189","Z0000","I4710","E039","D693","Z1231","L821","Z4802","Z466","N8111","Z90710","Z4689","Z1211","Z780","Z13820","M8580","I471","E785","N819","Z79890","I495","R195","Z5181","R92313","Z960","Z79621","M85852","R1110","Z45018","D6949","N8110","Z9079","Z90722","K5730","K644","M19042","I455","R6889"],"date":["2025-05-01","2025-09-09","2025-05-01","2025-02-07","2024-07-17","2022-11-09","2025-08-13","2025-02-21","2022-11-09","2025-01-16","2025-01-16","2025-01-16","2024-07-22","2025-02-05","2024-01-24","2023-10-06","2023-06-19","2025-06-05","2024-06-14","2025-06-05","2024-05-28","2025-07-16","2025-02-21","2025-03-05","2023-07-21","2024-07-26","2024-07-26","2025-07-30","2024-10-10","2023-03-23","2023-03-23","2023-03-23","2023-05-23","2025-05-20","2023-05-23","2025-06-05","2024-06-14","2024-10-10","2025-03-25","2025-07-16","2024-07-26","2025-02-05","2025-07-29","2024-08-29","2022-12-06","2024-05-09","2023-07-06","2023-07-06","2023-07-06","2024-10-10","2024-10-10","2024-12-09","2022-08-31","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":[["","","TACROLIMUS","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","ASTAGRAF XL","","","Select","Select",""],["","","LAGEVRIO (EUA)","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","ATOVAQUONE","","","Select","Select",""],["","","BENLYSTA","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","NYSTATIN","","","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":""}]}]}