{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Clarence T Robinson","gend":0,"currentgend":"","add":"16 Pheasant Way","city":"Hermon","state":"ME","zip":"04401","dob":"1957-06-12","age":"","mstatus":"","insh":"10000096827","cliId":"","pno":2073561744,"cno":"","email":"robison159@yahoo.com","ename":"","eno":"","pphy":"Courtney Tague","ppno":2078664399,"pcpadd":"Emmc Orono Family Medicine,84 Kelley Rd","pcpcity":"Orono","pcpstate":"ME","pcpzip":"04473","pcpcounty":"","pcpid":"","pcpname":"Northern Light Primary Care Brewer","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"16 Pheasant Way","madd2":"","madd3":"","mcity":"Hermon","mstate":"ME","mzip":"04401","pcpfaxno":2078664538,"pcpnpi":1679953194,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6KD9EE6XR34","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D469","K810","Z9484","Z5111","D61818","B449","J4481","D89811","Z87891","R0600","D709","U071","L03315","Z20822","D759","J986","C4442","B440","R053","E041","E042","L820","L821","J849","E43","J168","I82403","J189","M5417","I214","Z006","Z48813","J9811","J479","Z889","R1084","R918","M4807","L989","I252","R0602","Z87898","I21A1","N179","Z9481","I82463","D89813","Z5189","Z01818","D46Z","B4489","Z0000","H6123","J690","R590","L0889","B9689","R000","K5730","M899","L089","Z09","M5416","K819","C8400","R221","R1310","R6330","M4726","K5900","J449","M48061","Z7901","I82409","R220","K828","I82402","R109","N281","R059","C9201","M5136","B441","J4530","R0781","D61810","D696","M7989","M5432","M79605","C946","R269","Z452","R1013","D649","Z9221","Z0189","R0789","Z0101","H5203","H524","H52203","T8609","M4727","Z125","M8588","Z79899","Z434","M5127","M47817","D84821","C4492","R942","J45909","C9200","Z7951","R1011","Z0182","Z85828","M5137","Z8619","R5382","J029","R519","Q998"],"date":["2025-04-30","2023-01-18","2025-03-13","2023-12-04","2023-02-24","2023-08-03","2025-05-12","2025-05-12","2025-05-12","2025-05-12","2022-11-02","2022-11-02","2022-10-14","2023-02-03","2023-02-01","2022-10-10","2024-12-09","2024-11-17","2024-11-17","2023-08-29","2024-08-29","2023-07-17","2023-07-17","2023-07-17","2022-11-18","2022-11-18","2024-01-10","2023-10-11","2023-07-31","2023-07-31","2024-03-11","2024-02-21","2024-02-21","2025-02-19","2022-12-13","2022-12-05","2024-03-11","2023-05-26","2024-11-08","2024-01-10","2024-12-04","2024-01-10","2023-07-15","2023-07-15","2023-08-28","2023-07-13","2025-03-13","2024-12-12","2023-02-08","2023-02-01","2023-02-01","2025-06-10","2024-11-15","2023-07-15","2022-10-24","2022-10-27","2022-10-27","2023-07-12","2022-10-19","2023-01-11","2022-10-31","2022-11-29","2025-06-19","2022-12-09","2022-11-30","2022-11-30","2024-10-09","2024-10-09","2025-03-05","2022-10-11","2022-10-11","2025-04-30","2023-09-01","2023-08-01","2023-08-29","2022-11-14","2023-06-23","2022-12-05","2022-12-05","2023-08-28","2023-08-02","2023-06-27","2023-10-24","2022-09-13","2022-12-05","2022-12-05","2022-09-29","2024-10-09","2023-06-16","2023-06-16","2023-06-16","2023-06-16","2025-04-22","2022-11-29","2022-09-29","2022-09-29","2022-12-15","2022-12-05","2024-10-09","2024-10-09","2024-10-09","2024-10-09","2025-05-19","2025-04-30","2024-05-16","2023-01-11","2024-12-09","2022-12-09","2023-05-26","2023-05-26","2023-08-03","2025-06-10","2023-09-06","2023-09-06","2022-09-19","2023-10-24","2023-02-07","2023-02-07","2025-03-13","2023-05-26","2022-07-21","2022-07-21","2022-06-29","2022-06-29","2022-07-07"],"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":[["","","JAKAFI","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","TACROLIMUS","","","Select","Select",""],["","","ENOXAPARIN SODIUM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SYMBICORT","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","IBU","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","URSODIOL","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","BUDESONIDE","","","Select","Select",""],["","","VORICONAZOLE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","ZARXIO","","","Select","Select",""],["","","ATOVAQUONE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","OLANZAPINE ODT","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CRESEMBA","","","Select","Select",""],["","","INCRUSE ELLIPTA","","","Select","Select",""],["","","BREYNA","","","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":""}]}]}