{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Christie A Mullen","gend":1,"currentgend":"","add":"17 ALDER LN","city":"STANDISH","state":"ME","zip":"04084","dob":"1955-01-22","age":"","mstatus":"","insh":"10000101568","cliId":"","pno":2076712026,"cno":"","email":"christiemullen090@gmail.com","ename":"","eno":"","pphy":"BATES, GREGORY K","ppno":2078399101,"pcpadd":"Northern Light Mercy Health Center,409 Roosevelt Trl","pcpcity":"Windham","pcpstate":"ME","pcpzip":"04062","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"17 ALDER LN","madd2":"","madd3":"","mcity":"STANDISH","mstate":"ME","mzip":"04084","pcpfaxno":2078399201,"pcpnpi":1487022398,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7RQ4CV3QT75","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25511","M7551","Z1231","I471","L299","I480","I4719","I10","Z7901","I4710","Z79899","J069","C50511","R928","Z170","Q2112","G8929","G4700","Z853","N6489","R92332","R000","N6315","M25512","M7552","R6889","M7632","R92333","I499","I129","N189","L259","J45909","R519","R4182","M7631","M7061","M19011","Z23","Z1211","M7062","Z0101","H2513","H16223","M25551","R008","L570","R009","Z0100","M19012","I4720","I498","N6001","L03011"],"date":["2023-05-31","2024-05-22","2025-04-16","2023-03-27","2025-10-17","2025-04-30","2025-02-07","2025-02-07","2025-02-07","2025-04-30","2024-04-24","2024-03-18","2025-04-24","2025-04-24","2025-04-24","2023-03-27","2025-04-11","2023-09-29","2023-09-29","2025-04-21","2025-04-21","2023-02-06","2025-04-25","2024-08-26","2024-08-26","2023-04-08","2025-10-20","2025-10-28","2023-01-19","2023-01-18","2023-01-18","2023-07-20","2025-02-07","2025-02-07","2025-02-07","2024-06-24","2024-06-24","2024-05-22","2022-12-16","2025-08-22","2025-04-14","2024-07-31","2024-07-31","2024-07-31","2023-05-03","2023-02-07","2024-10-30","2023-01-18","2022-12-30","2023-07-26","2024-11-07","2024-11-07","2025-10-28","2023-11-22"],"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",""],["","","ELIQUIS","","","Select","Select",""],["","","ENALAPRIL MALEATE","","","Select","Select",""],["","","ZOLPIDEM TARTRATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","CEFDINIR","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","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":""}]}]}