{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Karen A Carey","gend":1,"currentgend":"","add":"124 LEWISTON RD","city":"NEW GLOUCESTER","state":"ME","zip":"04260","dob":"1957-03-10","age":"","mstatus":"","insh":"10000096143","cliId":"","pno":2079926426,"cno":"","email":"kosmein.mail@gmail.com","ename":"","eno":"","pphy":"KIM, REGINA Y","ppno":2075351340,"pcpadd":"MERCY WEST FALMOUTH PRIMARY CARE,75 GRAY RD","pcpcity":"FALMOUTH","pcpstate":"ME","pcpzip":"04105","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE WEST FALMOUTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"124 LEWISTON RD","madd2":"","madd3":"","mcity":"NEW GLOUCESTER","mstate":"ME","mzip":"04260","pcpfaxno":2075351358,"pcpnpi":1104906155,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4N92X78CC09","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25512","M7602","R5383","I10","S83422A","R2689","M25562","M19041","M65331","M65311","M1712","M779","Z0000","Z780","M0579","Z79899","D123","K219","Z0001","R42","E785","M069","M47812","Z8669","M25552","M48062","M6281","N3946","M9905","Z13820","F17210","Z86010","K5730","Z23","M5450","M5416","Z1231","M7138","Z4789","M4807","M06012","M4802","M109","M48061","L814","L308","M75112","N3941","S79912A","M160","D84821","M0550","F325","F17200","U071","H25093","G629","H0015"],"date":["2025-07-11","2025-05-19","2024-08-05","2025-09-03","2024-07-29","2024-07-29","2024-07-29","2023-10-23","2025-04-11","2024-07-18","2024-03-12","2024-03-12","2025-09-22","2023-12-22","2025-10-20","2023-08-16","2023-01-04","2023-01-04","2024-09-09","2024-09-09","2025-09-03","2023-09-11","2024-08-19","2023-09-11","2025-10-20","2025-07-17","2025-04-18","2025-04-18","2025-04-18","2023-12-22","2025-01-31","2023-01-04","2023-01-04","2023-03-06","2025-07-17","2025-09-06","2024-10-18","2025-09-03","2025-10-07","2025-10-20","2025-01-31","2023-08-16","2023-08-16","2025-09-03","2025-04-17","2025-04-17","2025-10-20","2025-03-17","2025-01-31","2025-01-31","2024-11-10","2024-11-10","2024-11-10","2025-03-17","2022-10-28","2022-10-14","2022-09-30","2022-08-23"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","NICOTROL","","","Select","Select",""],["","","VARENICLINE TARTRATE","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","TOBRADEX","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","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":""}]}]}