{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ronald A Kofstad","gend":0,"currentgend":"","add":"85 HANSON LAKE RD","city":"MAPLETON","state":"ME","zip":"04757","dob":"1937-02-09","age":"","mstatus":"","insh":"10000093967","cliId":"","pno":2077643072,"cno":"","email":"declined@121125.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":"85 HANSON LAKE RD","madd2":"","madd3":"","mcity":"MAPLETON","mstate":"ME","mzip":"04757","pcpfaxno":2077608170,"pcpnpi":1689025959,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5PP0HJ9FT14","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I2510","I10","Z7982","Z7902","K5790","K5909","K649","R12","K449","E7849","N481","R109","N401","R0789","H25813","H17822","H04123","H43813","N200","N138","Z79899","R350","R6889","N202","K130","D649","M5450","M533","B3783","R2689","M940","V8695XA","R7303","K149","Z0000","Z7984","Z87891","R9431","Z09","R0982","R110","K219","L309","Z466","K6289","E119","K439","B349","B370","N201","R351","N3943","K1370","K146","Z87442","H35371","R079","J069","S60811A","K2100","R3912","K2270","R194","M25512","R142","R739","W450XXA","I25119","E785","R140","J0190","R051","I25118","H903","K31A11","K2950"],"date":["2025-04-23","2025-04-23","2025-04-23","2025-04-23","2024-01-02","2024-04-30","2024-04-30","2023-07-10","2023-07-10","2023-07-10","2022-11-17","2022-12-09","2025-04-08","2024-12-19","2025-03-26","2024-02-08","2022-12-16","2025-03-26","2025-04-08","2025-04-08","2025-04-08","2023-09-26","2023-12-27","2022-12-29","2023-03-22","2023-09-13","2025-09-12","2025-09-12","2022-12-21","2024-01-04","2025-04-23","2025-04-23","2025-06-12","2023-03-22","2023-10-11","2024-09-04","2024-04-30","2023-04-05","2024-07-24","2024-07-24","2024-06-25","2024-07-24","2023-03-01","2023-01-12","2023-12-18","2025-03-26","2022-11-25","2024-01-12","2023-05-05","2023-01-04","2023-03-27","2023-03-27","2023-04-06","2023-04-06","2023-01-04","2025-03-26","2025-01-20","2024-06-20","2024-05-21","2023-07-10","2023-02-13","2023-05-05","2023-12-18","2024-02-01","2022-11-25","2023-09-13","2024-05-21","2025-03-03","2025-03-03","2024-04-30","2023-05-26","2023-05-26","2025-03-03","2022-08-31","2022-06-16","2022-06-16"],"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":[["","","SUCRALFATE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","LINZESS","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","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":""}]}]}