{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan C Huff","gend":1,"currentgend":"","add":"131 MOUNT RD","city":"BURNHAM","state":"ME","zip":"04922","dob":"1948-02-21","age":"","mstatus":"","insh":"10000099529","cliId":"","pno":2077451581,"cno":"","email":"Susanhuff53@gmail.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":"131 MOUNT RD","madd2":"","madd3":"","mcity":"BURNHAM","mstate":"ME","mzip":"04922","pcpfaxno":2078613281,"pcpnpi":1497800734,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5N36F08QY51","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S80862A","I10","E785","K219","L03116","W57XXXA","L989","R195","L409","Z1231","Z1283","Z0000","L820","D509","L738","L821","D225","L570","Z0101","E039","Z23","J449","D485","Z1211","R319","D649"],"date":["2024-08-06","2025-01-21","2025-04-09","2023-08-02","2024-08-06","2024-08-06","2024-01-17","2023-08-02","2025-07-14","2025-04-03","2024-02-20","2025-03-10","2025-07-14","2023-07-17","2024-02-20","2024-07-16","2024-02-20","2025-07-14","2023-09-28","2023-10-11","2023-09-20","2023-04-26","2024-07-16","2022-10-26","2022-11-23","2022-10-20"],"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":[["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","WIXELA INHUB","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","ADVAIR DISKUS","","","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":""}]}]}