{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kathleen R Wood","gend":1,"currentgend":"","add":"491 MAIN RD","city":"EDDINGTON","state":"ME","zip":"04428","dob":"1938-07-31","age":"","mstatus":"","insh":"10000101033","cliId":"","pno":2078437706,"cno":"","email":"bearriver38@gmail.com","ename":"","eno":"","pphy":"RONCO, PAUL G","ppno":2079476141,"pcpadd":"43 WHITING HILL RD,SUITE 300","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121005","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"491 MAIN RD","madd2":"","madd3":"","mcity":"EDDINGTON","mstate":"ME","mzip":"04428","pcpfaxno":2079476720,"pcpnpi":1033152582,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8MW0W33DT29","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H353231","H43393","H43813","G43B0","S8254XA","S82841D","S92811A","G7000","G5603","S8254XD","W19XXXD","M5450","M47896","M461","L821","S8291XA","S82891A","M810","Z0101","S82891D","S63611A","S63201A","W230XXA","E785","N200","K7689","K824","Z0000","S8251XD","E039","L509","Z7982","H353290","M151","M152","R002","Z961","Z13820","G5623","Z0001","E8352","I10","H353230","M1612","M79671","R7989","Z79899","R945","V888XXA","Y92093","W19XXXA"],"date":["2025-10-27","2024-08-20","2024-08-20","2024-08-20","2025-06-05","2025-07-15","2025-05-20","2024-10-24","2025-10-28","2025-08-13","2025-09-08","2025-04-24","2025-04-24","2025-04-24","2024-04-16","2025-06-05","2025-06-05","2025-08-26","2025-02-21","2025-09-08","2023-09-05","2023-08-25","2023-09-05","2025-06-10","2025-05-28","2025-05-28","2025-05-28","2024-04-01","2025-09-08","2024-10-24","2023-01-31","2023-09-05","2023-09-28","2023-08-25","2023-08-25","2023-02-01","2024-06-24","2024-05-09","2025-10-28","2025-04-28","2025-10-10","2024-06-05","2024-06-05","2024-06-05","2025-05-20","2025-08-26","2024-06-19","2025-08-26","2025-05-20","2025-05-20","2025-06-05"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","PYRIDOSTIGMINE BROMIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","PROLIA","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","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":""}]}]}