{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gayle M Phillips","gend":1,"currentgend":"","add":"40 PENOBSCOT ST","city":"ORONO","state":"ME","zip":"04473","dob":"1955-05-11","age":"","mstatus":"","insh":"10000097152","cliId":"","pno":2076592427,"cno":"","email":"jdmcc@yahoo.com","ename":"","eno":"","pphy":"HUERTH, BENJAMIN W","ppno":2079737979,"pcpadd":"Penobscot Nation Health Dept,23 Wabanaki Way","pcpcity":"Indian Island","pcpstate":"ME","pcpzip":"04468","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT FAMILY MEDICINE AND RESIDENCY","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"40 PENOBSCOT ST","madd2":"","madd3":"","mcity":"ORONO","mstate":"ME","mzip":"04473","pcpfaxno":2078177459,"pcpnpi":1467658112,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3TM6GY5AJ55","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z122","F419","R0789","K8020","H40013","F339","M1712","S83241A","R109","I10","M25562","Z4789","M5136","E876","Z23","M1732","R059","U071","F411","R6889","J449","R079","M23321","M23351","S83281A","M25552","M12861","E039","D649","J988","Z87891","Z1231","M25561","Z471","Z96651","M23221","M23251","R42","I951","E860","M1711","X58XXXA","I340","J40","R1900","G5711","E782","F418","Z96652","H40023","M47816","M4186","S79912A","M25512","Z09","M25569","R4589","R790","M79602","M170","M25462","F410","Z8659","F13239","R110","K219","G2581","M5432","M48061","M5127","M5137","M47817","F17210","R634","Z86010","Z1211","Z713","Z20822","D124","K5730","K640","D122","M79604","M8580","H6990","H6121"],"date":["2024-12-06","2025-10-30","2025-03-14","2025-11-06","2023-10-11","2025-08-24","2025-06-26","2023-08-08","2025-10-30","2025-06-06","2025-09-02","2025-09-02","2023-08-16","2025-10-30","2025-09-24","2025-06-26","2025-02-06","2024-02-29","2025-09-12","2023-10-03","2025-01-24","2025-03-14","2023-03-01","2023-03-01","2023-08-08","2023-08-02","2023-08-30","2023-10-24","2025-09-04","2025-01-26","2025-01-26","2025-04-03","2023-03-20","2025-10-31","2025-07-10","2023-08-08","2023-08-08","2024-05-08","2024-05-08","2024-05-08","2023-05-26","2023-05-26","2025-06-06","2025-05-16","2025-11-06","2025-10-31","2023-08-30","2023-07-31","2025-10-31","2024-06-27","2023-08-16","2023-08-16","2023-08-16","2023-03-20","2025-08-26","2025-06-12","2025-07-28","2025-09-17","2024-11-25","2024-04-22","2024-04-22","2025-09-05","2025-08-21","2025-08-22","2024-11-15","2024-11-15","2023-12-19","2023-12-19","2024-01-24","2024-01-24","2024-01-24","2024-01-24","2024-12-06","2022-11-10","2022-11-10","2022-11-01","2022-10-26","2022-10-25","2022-11-01","2022-11-01","2022-11-01","2022-11-01","2022-11-19","2022-09-29","2022-08-08","2022-08-08"],"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":[["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","MEDROL","","","Select","Select",""],["","","ZITHROMAX","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","PRENATAL VITAMIN PLUS LOW IRON","","","Select","Select",""],["","","UROCIT-K","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","LOSARTAN-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","LOPERAMIDE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","MIEBO","","","Select","Select",""],["","","ARMOUR THYROID","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","PREPLUS","","","Select","Select",""],["","","IBUPROFEN","","","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":""}]}]}