{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michael S Freese","gend":0,"currentgend":"","add":"174 MAIN ST","city":"BRADLEY","state":"ME","zip":"04411","dob":"1956-09-14","age":"","mstatus":"","insh":"10000094736","cliId":"","pno":2078273718,"cno":2077457765,"email":"dvc45@roadrunner.com","ename":"","eno":"","pphy":"RONCO, PAUL G","ppno":2079476141,"pcpadd":"43 WHITING HILL RD,SUITE 300","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121005","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 478","madd2":"","madd3":"","mcity":"BRADLEY","mstate":"ME","mzip":"04411","pcpfaxno":2079476720,"pcpnpi":1033152582,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9CJ0V49CA16","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5450","M25561","I25118","I4891","E1165","F330","M47812","M542","J329","I5032","T783XXA","I255","I209","E11622","M170","M1812","S40812A","U071","M722","M1711","I509","L570","I25119","I5033","Z7982","C44229","L910","M1811","Z0189","Z1211","H40043","H401131","H01021","H01024","Z48817","L918","R208","L538","D485","D2371","L821","L818","Z08","H16223","H0289","C44329","R6889","Z09","L03115","H26492","M25511","M1712","R202","M4726","H26493","E119","Q5310","N433","N442","R55","M5417","M7138","H04123","H02051","G629","D225","L814","M79672","M5117","M4727","H26491","H16141","I110","N50811","M549","E113293","Z0101","R079","L298","Z794","G4733","Z9989","G458","I6523","L239","H40003","H40053","Z4800","R519","H538","H0520","M47814","M47816","R911","M23303","M25461","R0981","R112","Z7689","R109","D3611","Z23","Z7189","Z0000","L820","Z789","I872","R42","H5711","Z125","L97219","H2511","Z955","H2512","M180","I440","I493","I491","M79661","S86001A","H2513","H25041"],"date":["2025-06-17","2023-12-23","2023-02-16","2023-02-16","2025-02-19","2023-02-16","2024-03-05","2024-02-16","2023-10-12","2023-10-19","2023-07-21","2024-06-27","2023-07-21","2025-06-24","2025-06-23","2025-06-23","2024-08-13","2023-10-06","2023-10-06","2025-02-07","2024-05-22","2025-08-26","2024-06-27","2024-06-27","2024-06-27","2023-08-17","2023-08-02","2024-05-08","2023-08-22","2023-07-12","2023-09-05","2023-09-05","2023-09-05","2023-09-05","2023-08-17","2025-08-26","2025-08-26","2025-02-25","2023-07-24","2023-02-03","2025-08-26","2025-02-25","2023-02-03","2025-01-30","2025-01-31","2023-07-24","2023-10-04","2024-07-17","2025-06-17","2023-03-30","2023-01-19","2025-02-13","2025-02-13","2024-07-23","2023-02-24","2023-02-24","2023-09-25","2023-09-25","2023-09-25","2025-05-11","2024-04-25","2024-11-07","2024-04-23","2024-04-23","2025-02-14","2025-08-26","2025-08-26","2023-11-10","2024-06-01","2024-06-01","2023-04-13","2024-11-15","2023-10-19","2023-08-22","2024-03-20","2024-12-31","2024-12-31","2025-07-29","2024-02-08","2025-06-24","2022-12-15","2022-12-15","2024-02-08","2024-02-08","2023-06-30","2025-06-04","2025-06-04","2025-06-30","2024-02-16","2024-02-16","2024-02-16","2024-03-05","2024-03-05","2024-03-02","2023-12-23","2023-12-23","2023-08-22","2023-08-22","2024-01-30","2023-10-19","2023-02-03","2024-01-30","2024-01-30","2024-01-19","2025-08-26","2025-08-26","2025-08-26","2025-05-22","2024-01-19","2024-01-19","2025-06-24","2022-10-26","2022-10-25","2022-10-12","2022-10-03","2022-09-14","2022-09-14","2022-09-14","2022-09-29","2022-08-31","2022-09-07","2022-06-28"],"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":[["","","DEXCOM G7 RECEIVER","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","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":[]}},{"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":""}]}]}