{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lucy S Moore","gend":1,"currentgend":"","add":"7 KYLE ST","city":"Brunswick","state":"ME","zip":"04011","dob":"1943-12-04","age":"","mstatus":"","insh":"10000101679","cliId":"","pno":2063889948,"cno":"","email":"lucyat1204@gmail.com","ename":"","eno":"","pphy":"KIM, REGINA Y","ppno":2075351340,"pcpadd":"MERCY WEST FALMOUTH PRIMARY CARE,75 GRAY RD","pcpcity":"FALMOUTH","pcpstate":"ME","pcpzip":"04105","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE WEST FALMOUTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"7 KYLE ST","madd2":"","madd3":"","mcity":"BRUNSWICK","mstate":"ME","mzip":"04011","pcpfaxno":2075351358,"pcpnpi":1104906155,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7HN0TN5WN09","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E119","R5383","E7800","M5431","E785","E7841","R0902","M79674","I083","B351","N1831","I10","E8352","D509","B251","N1832","N189","E839","Z0000","H9190","D649","E039","M9903","M5417","M9904","M461","R079","I129","M8589","Z0131","E559","E349","I890","H35362","H04123","R0789","R262","L603","J181","R42","D72829","Z1231","M5430","E538","R059","I351","J189","Z7982","J9610","I080","N1830","I700","J309","R6889","M79671","R0982","F1920","H903","Z0001","H52223"],"date":["2023-10-17","2025-04-29","2023-11-17","2023-09-29","2025-08-01","2025-01-06","2025-11-16","2023-04-03","2024-01-19","2024-04-03","2023-12-14","2025-07-11","2023-03-03","2023-07-05","2024-02-07","2025-07-11","2025-07-11","2025-07-11","2023-10-27","2024-06-03","2023-10-17","2023-10-17","2025-01-17","2025-01-17","2025-01-17","2025-01-17","2025-07-24","2025-05-05","2024-12-09","2025-08-14","2024-10-30","2024-10-30","2025-10-28","2025-03-06","2025-03-06","2025-07-22","2024-04-03","2023-03-30","2024-09-29","2024-09-29","2024-09-29","2024-12-09","2023-07-05","2023-07-05","2024-09-29","2025-09-04","2024-10-17","2023-02-13","2023-11-30","2025-01-20","2025-04-29","2024-09-29","2023-10-27","2023-03-28","2024-07-07","2023-04-13","2023-04-13","2024-12-12","2024-11-04","2025-03-06"],"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":[["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","CICLOPIROX","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","TERBINAFINE HCL","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","SPIKEVAX 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":[]}},{"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":""}]}]}