{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Julie A Young","gend":1,"currentgend":"","add":"70 BRADFORD LN","city":"South China","state":"ME","zip":"04358","dob":"1968-05-05","age":"","mstatus":"","insh":"10000091234","cliId":"","pno":2076168095,"cno":"","email":"DAVEATBTS@GMAIL.COM","ename":"","eno":"","pphy":"DAY, BETHANY N","ppno":2073685747,"pcpadd":"Northern Light Health Center Newport Plaza,26 Main St Ste 2","pcpcity":"Newport","pcpstate":"ME","pcpzip":"04953","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HEALTH CENTER NEWPORT PLAZA","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"70 BRADFORD LN","madd2":"","madd3":"","mcity":"South China","mstate":"ME","mzip":"04358","pcpfaxno":2073685483,"pcpnpi":1023361953,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4JN2U04QW96","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","F419","F32A","F17210","Z1151","Z01419","R109","G40802","K089","R600","Z1211","S0990XA","W1830XA","K644","L918","Z5321","H6122","R112","F17200","K660","G8929","Z79899","Z98890","K649","D122","R1031","Z1152","Z122","K561","Q675","K529","K769","R932","N854","N12","R110","R509","B9620","Z0100","R519","M41126","K760","R300","I700","F325","R059","M419","R569","T8131XA","R1111","E785","M5137","R200","R202","Z23","M7711","Z09","R1032","R531","S301XXD","T148XXA","K635","Z86010","Z8639","L98499"],"date":["2025-08-27","2025-06-18","2024-06-21","2024-08-12","2023-10-13","2023-10-13","2025-05-30","2025-08-22","2023-04-20","2023-04-20","2022-10-27","2023-12-01","2023-12-01","2024-10-21","2024-10-21","2025-02-10","2024-06-11","2025-07-16","2025-06-18","2024-06-21","2025-04-28","2025-04-28","2024-07-18","2024-08-12","2022-10-27","2025-07-16","2025-07-15","2023-11-14","2024-06-21","2025-02-27","2025-02-11","2025-02-11","2025-02-11","2025-02-11","2023-06-15","2023-06-15","2023-06-15","2023-06-15","2025-04-02","2025-08-22","2023-05-05","2025-07-16","2023-06-13","2023-06-13","2024-07-15","2025-02-11","2024-07-15","2025-03-08","2024-07-08","2025-07-15","2024-06-21","2023-05-05","2023-05-05","2023-05-05","2023-11-14","2025-03-25","2025-07-21","2024-06-19","2023-12-01","2024-07-10","2024-07-10","2022-10-27","2022-10-27","2025-07-21","2022-07-05"],"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":[["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","LEVETIRACETAM","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","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":""}]}]}