{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Anna B Crane","gend":1,"currentgend":"","add":"10 COLONIAL CIR APT 215","city":"BREWER","state":"ME","zip":"04412","dob":"1947-03-15","age":"","mstatus":"","insh":"10000101734","cliId":"","pno":2073569654,"cno":"","email":"annaknitter47@yahoo.com","ename":"","eno":"","pphy":"KNIPSCHER, KATHLEEN A","ppno":2079890550,"pcpadd":"Eastern Maine Medical Center,43 Whiting Hill Rd","pcpcity":"Brewer","pcpstate":"ME","pcpzip":"04412","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"10 COLONIAL CIR APT 215","madd2":"","madd3":"","mcity":"BREWER","mstate":"ME","mzip":"04412","pcpfaxno":2079890551,"pcpnpi":1376071894,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3G44Q47UQ75","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J029","Z09","Z96642","M48061","N390","F411","I10","Z87891","M533","M2578","M5136","B349","M47816","Z0000","M9913","M9912","M9911","M25552","I493","I517","M5116","M5450","R21","B354","M9916","H5202","H2513","R5383","R079","N760","R350","R002","S63501A","I088","I161","Z1231","R200","R202","B351","M9903","M9904","M9905","M9906","Z791","Z79899","R0602","E785","Z0001","F331","R6889","R300","Z96653","M5117","M4727","M4316"],"date":["2023-04-27","2024-10-10","2024-10-10","2024-08-12","2023-05-12","2025-03-10","2025-01-29","2023-06-23","2023-12-29","2023-01-31","2023-08-02","2023-12-13","2023-08-15","2024-12-23","2025-11-14","2025-11-14","2025-11-14","2024-04-24","2024-09-09","2024-09-09","2024-08-12","2025-04-22","2023-03-24","2023-02-14","2024-07-24","2025-03-06","2025-03-06","2025-05-30","2025-01-29","2023-06-23","2023-10-16","2024-09-23","2023-08-30","2024-09-09","2025-01-31","2024-07-19","2023-08-30","2023-08-30","2025-06-30","2023-11-17","2023-11-17","2023-11-17","2023-11-17","2023-06-08","2023-06-08","2025-01-29","2023-01-13","2025-09-09","2025-10-15","2023-01-28","2023-06-30","2023-06-20","2024-08-12","2024-08-12","2024-08-12"],"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":[["","","TRAMADOL HCL","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","IBU","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","TERBINAFINE HCL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","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":""}]}]}