{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Leona R Smith","gend":1,"currentgend":"","add":"311 LINDSAY RD","city":"NEWBURGH","state":"ME","zip":"04444","dob":"1959-02-15","age":"","mstatus":"","insh":"10000099869","cliId":"","pno":2079444067,"cno":"","email":"leonasmith1959@gmail.com","ename":"","eno":"","pphy":"Young, Amanda M","ppno":2079437752,"pcpadd":"NORTHERN LIGHT PRIMARY CARE MILO,135 PARK ST","pcpcity":"MILO","pcpstate":"ME","pcpzip":"04463","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE MILO","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"311 LINDSAY RD","madd2":"","madd3":"","mcity":"NEWBURGH","mstate":"ME","mzip":"04444","pcpfaxno":2079431002,"pcpnpi":1578791760,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6FA3W61PQ71","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K449","M25511","G8929","M1711","Z1231","Z48815","E785","I10","M25561","Z98890","Z0000","Z0100","R6889","M19011","K219","Z87891","H40003","S40862A","S70262A","W57XXXA","M1812","M19042","M1A9XX0","R1013","M8589","M25512","R1310","K2100","K5909","R251","M797","M19012","N898","M159","R12","J329","N760","M7552"],"date":["2023-10-12","2023-08-22","2023-08-22","2024-07-25","2024-09-19","2023-06-22","2025-03-31","2025-03-31","2023-08-22","2023-06-15","2025-03-31","2025-06-02","2023-12-06","2024-04-09","2023-06-12","2025-06-03","2025-06-02","2025-05-02","2025-05-02","2025-05-02","2025-05-06","2025-05-06","2024-04-09","2022-11-16","2024-09-19","2024-06-17","2023-10-12","2023-10-12","2023-10-12","2022-12-14","2024-04-09","2024-06-17","2025-06-03","2023-04-11","2023-04-19","2024-10-16","2025-06-03","2024-07-25"],"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":[["","","CELECOXIB","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","LINZESS","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","ETODOLAC","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUARIX QUAD 2023-2024","","","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":""}]}]}