{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Richard E Libby","gend":0,"currentgend":"","add":"979 ESSEX ST LOT 448","city":"BANGOR","state":"ME","zip":"04401","dob":"1958-01-10","age":"","mstatus":"","insh":"10000101560","cliId":"","pno":2079746198,"cno":"","email":"","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":"979 ESSEX ST LOT 448","madd2":"","madd3":"","mcity":"BANGOR","mstate":"ME","mzip":"04401","pcpfaxno":2079476720,"pcpnpi":1033152582,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9NC5ED5FR63","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C19","Z5111","E1165","Z0000","A419","N3000","Z09","I10","Z933","Z85038","D869","C189","H2511","Z433","C787","D509","R918","C779","Z1211","R590","R0602","K6389","C187","Z5331","R509","R531","I491","N390","N281","Z0101","H52223","H43393","C785","C186","R591","H2512","C772","B9689","R7881","Z9221","E113412","K7689","Z79899","Z510","E8342","Z9049","E1169","E669","E782","J9811","K922","D127","D123","D128","K5730","K529","A4151","Z4689","R5383","K9400","D709","H401411","E113293","D500","K769","Z23","Z961","E113291","E113212","Z452","K921","C188","L03818","Z8639","R319","K9189","N3001","D649","B369","R350","R160","K635","C7951","R000"],"date":["2025-09-02","2025-08-05","2025-06-17","2025-06-17","2023-10-05","2023-08-21","2023-08-21","2025-07-09","2025-08-21","2025-08-21","2025-09-10","2025-07-17","2024-06-24","2024-01-04","2025-07-09","2025-07-22","2023-11-15","2024-12-18","2025-07-17","2025-09-10","2023-08-28","2023-05-24","2025-03-25","2023-10-10","2023-09-18","2023-09-18","2023-09-18","2023-09-18","2025-04-24","2024-04-16","2024-10-01","2024-04-16","2024-11-06","2025-04-07","2023-08-02","2024-09-04","2025-01-21","2023-08-07","2023-08-06","2023-08-06","2025-09-11","2024-10-03","2025-07-22","2025-04-01","2023-09-18","2024-09-25","2023-04-03","2023-04-03","2023-09-08","2025-01-22","2023-05-11","2023-05-10","2023-05-10","2023-05-10","2023-05-10","2024-11-15","2023-09-18","2024-05-24","2024-05-10","2024-11-01","2023-07-12","2025-02-18","2023-04-05","2023-05-24","2024-03-25","2024-06-10","2025-02-18","2025-02-18","2025-02-18","2023-06-12","2023-05-10","2025-01-21","2025-08-26","2023-05-09","2025-08-26","2025-04-24","2023-09-18","2025-08-29","2025-08-26","2025-08-26","2024-07-01","2023-05-11","2024-11-18","2023-09-18"],"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":[["","","OXYCODONE HCL","","","Select","Select",""],["","","CAPECITABINE","","","Select","Select",""],["","","RYBELSUS","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","NEOMYCIN SULFATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","MOXIFLOXACIN","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","ONDANSETRON HCL","","","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":{"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}