{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"David W Bouchey","gend":0,"currentgend":"","add":"5 EMERALD RD","city":"Holden","state":"ME","zip":"04429","dob":"1962-03-29","age":"","mstatus":"","insh":"10000096995","cliId":"","pno":2073856390,"cno":"","email":"davidbouchey@gmail.com","ename":"","eno":"","pphy":"ISENHOWER, LORI S","ppno":2079737979,"pcpadd":"EMMC Family Medicine Center and Residency,895 Union St Ste 12","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT FAMILY MEDICINE AND RESIDENCY","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5 EMERALD RD","madd2":"","madd3":"","mcity":"Holden","mstate":"ME","mzip":"04429","pcpfaxno":2079479579,"pcpnpi":1538518170,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1R87U68RM46","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R5381","R531","R269","R262","F325","F331","N453","R0602","I10","M159","K5900","R140","Z713","R7303","Z6830","F419","N433","N1330","N319","A4151","A419","F411","R32","Z0101","H5212","H524","H52203","J45909","Z09","J3089","R0982","J329","J383","J45990","G478","R300","F321","Z0000","N393","Z87440","W19XXXA","R0600","R399","M25562","M1711","R0609","N281","Z6829","E785","R5383","I2510","R079","M25561","M6281"],"date":["2025-08-13","2025-08-13","2025-08-13","2025-08-13","2024-03-22","2024-11-19","2025-04-12","2024-02-06","2024-03-22","2024-03-22","2025-04-04","2025-04-04","2023-08-29","2023-08-29","2023-08-29","2024-12-17","2025-04-01","2025-04-01","2025-05-21","2025-04-01","2025-04-12","2025-01-07","2024-04-09","2025-05-06","2025-05-06","2025-05-06","2025-05-06","2023-05-10","2025-04-21","2024-08-27","2024-08-27","2024-08-27","2024-08-27","2024-06-19","2024-06-19","2023-01-04","2023-05-18","2024-08-23","2022-12-08","2023-01-27","2023-04-04","2022-12-30","2023-01-13","2025-07-31","2025-07-31","2025-07-25","2023-01-27","2023-05-02","2022-08-08","2022-08-08","2022-07-11","2022-07-11","2022-07-07","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":[["","","PREDNISOLONE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","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":{"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":[]}},{"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":""}]}]}