{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy E Griffin","gend":1,"currentgend":"","add":"211 SPRAGUEVILLE RD","city":"PRESQUE ISLE","state":"ME","zip":"04769","dob":"1957-04-23","age":"","mstatus":"","insh":"10000096345","cliId":"","pno":2077646364,"cno":2075518501,"email":"griffinpt@juno.com","ename":"","eno":"","pphy":"MACHARIA, THOMAS C","ppno":2077643142,"pcpadd":"146 ACADEMY ST,","pcpcity":"PRESQUE ISLE","pcpstate":"ME","pcpzip":"47693102","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE MARS HILL","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"211 SPRAGUEVILLE RD","madd2":"","madd3":"","mcity":"PRESQUE ISLE","mstate":"ME","mzip":"04769","pcpfaxno":2077608170,"pcpnpi":1881853919,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2T10AY5CG25","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R300","M2550","N3090","N814","Z4789","Z48815","H25812","M1812","N813","S52515A","W11XXXA","S62102A","Z0001","Z0000","S52502D","S52502A","K2980","R760","J329","Z1231","X58XXXD","N390","K317","K2100","R6889","Z961","H43813","H26492","K2289","Z0101","Z9842","Z780","R1310","K219","Z01419","Z87440","R399","R92313","S6992XA","S6292XA","L918","H168","H2512","D72819","R739","Z1159","Z13820","M8589","E2839","Z23","Z9841"],"date":["2025-04-18","2025-08-18","2024-06-20","2024-06-20","2025-06-04","2024-06-14","2024-06-10","2025-08-15","2025-04-30","2025-04-30","2025-04-30","2025-08-14","2025-07-28","2024-07-22","2025-07-10","2025-04-30","2024-06-03","2025-10-10","2024-12-11","2025-03-14","2025-07-10","2025-09-16","2024-06-03","2024-06-03","2023-12-30","2024-09-11","2025-10-15","2025-10-15","2024-05-09","2024-07-30","2024-07-30","2025-10-27","2024-05-09","2024-05-09","2023-12-04","2023-12-04","2023-12-04","2025-03-14","2025-04-25","2025-06-04","2023-10-20","2025-07-30","2024-05-01","2025-07-28","2025-07-28","2025-07-28","2022-10-27","2022-10-27","2022-10-27","2022-11-21","2022-07-13"],"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":[["","","CEPHALEXIN","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","SHINGRIX","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}