{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Clayton L Sims","gend":0,"currentgend":"","add":"312 SOUTH FREEDOM RD","city":"ALBION","state":"ME","zip":"04910","dob":"1950-07-14","age":"","mstatus":"","insh":"10000096486","cliId":"","pno":2074372545,"cno":2076491364,"email":"declined@080122.com","ename":"","eno":"","pphy":"KRIEGEL, CHARLES B","ppno":"","pcpadd":"Sebasticook Valley Health,80 Main St","pcpcity":"Unity","pcpstate":"ME","pcpzip":"04988","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HEALTH CENTER UNITY","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 262","madd2":"","madd3":"","mcity":"ALBION","mstate":"ME","mzip":"04910","pcpfaxno":2078613281,"pcpnpi":1497800734,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7EA8TX2ED31","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z5111","C8339","Z79632","Z79630","Z79633","Z452","C8590","I4891","I493","I10","C8510","R222","Z905","Z85528","Z8679","Z08","Z8572","R945","Z9221","I480","C8330","I77810","I428","R109","R079","R0600","Z8553","N2889","Z7689","R918","C8519","C8332","I4710","I517","C8334","C641","Z5181","I491","L905","R002","R591","R110","I7121","F411","Z79899","Z0000","H5203","H52223","H524","Z7982","G4733","N281","Z0101","H2513","H40033","C8338","Z79620","R748","D72828","T458X5A","Z7901","Z23","R6889","Z0001","D123","Z1211","Z86010","K5730","C649","N1330"],"date":["2023-12-06","2024-02-15","2023-12-06","2023-12-06","2023-12-06","2024-03-05","2024-03-05","2025-09-08","2023-10-31","2025-03-25","2023-08-29","2023-08-03","2023-08-10","2023-08-10","2023-07-24","2025-06-18","2024-12-18","2024-12-18","2024-12-18","2025-04-07","2023-08-25","2025-06-02","2024-02-22","2023-10-04","2023-10-04","2023-10-04","2023-08-23","2023-08-23","2023-12-08","2023-07-07","2023-08-03","2023-08-03","2023-11-24","2025-06-02","2023-09-12","2023-09-12","2023-08-16","2024-10-23","2024-06-18","2024-11-11","2023-11-10","2023-09-13","2025-06-02","2024-09-24","2023-08-16","2024-10-21","2024-09-26","2024-09-26","2024-09-26","2023-07-21","2025-03-25","2023-07-07","2024-09-26","2024-09-26","2024-09-26","2023-08-25","2023-08-25","2023-12-18","2023-12-18","2023-12-18","2023-08-31","2022-11-16","2022-11-15","2022-09-15","2022-08-09","2022-08-09","2022-08-09","2022-08-09","2022-08-01","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":[["","","ELIQUIS","","","Select","Select",""],["","","MIRTAZAPINE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","PAXLOVID (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":""}]}]}