{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Joseph J Brochu","gend":0,"currentgend":"","add":"17 BRIGHTEN AVE","city":"VINALHAVEN","state":"ME","zip":"04863","dob":"1961-07-24","age":"","mstatus":"","insh":"10000098267","cliId":"","pno":2076591318,"cno":"","email":"joebrochu1961@gmail.com","ename":"","eno":"","pphy":"Kanumalla, Raghu","ppno":2079890550,"pcpadd":"NORTHERN LIGHT PRIMARY CARE BREWER,234 STATE ST","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"04412","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 16","madd2":"","madd3":"","mcity":"VINALHAVEN","mstate":"ME","mzip":"04863","pcpfaxno":2079890551,"pcpnpi":1497313696,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3G58G65CF50","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z95810","H903","Z0101","G3184","J069","I4720","I469","Z79899","S6991XA","S6992XA","I252","I10","I2510","I5022","M25511","I340","Z0000","E785","R7301","R5383","G40909","I509","I110","S63682A","S63601A","K023","Z1211","Z86010","K648","Z23","H90A21","H90A31","H9319","J0100","R002","I4510","Z8249"],"date":["2025-04-15","2025-01-21","2024-11-20","2023-09-18","2023-02-16","2025-01-13","2023-07-14","2025-01-27","2023-03-17","2023-03-17","2023-08-09","2024-06-07","2025-02-04","2023-05-17","2024-10-15","2023-05-17","2025-01-16","2024-07-24","2024-07-24","2023-08-14","2025-01-16","2023-08-16","2023-08-16","2023-03-17","2023-03-17","2025-03-19","2022-11-01","2022-11-01","2022-11-01","2022-11-04","2022-10-05","2022-10-05","2022-10-05","2025-02-10","2022-10-18","2022-10-18","2022-10-18"],"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":[["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","CARBAMAZEPINE ER","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","METAXALONE","","","Select","Select",""],["","","OMEPRAZOLE","","","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":""}]}]}