{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jane L Shipman","gend":1,"currentgend":"","add":"195 PROSPECT POINT RD","city":"PROSPECT HARBOR","state":"ME","zip":"04669","dob":"1952-05-14","age":"","mstatus":"","insh":"10000102498","cliId":"","pno":8607590793,"cno":"","email":"jzbcycle@gmail.com","ename":"","eno":"","pphy":"OBRIEN, BENJAMIN H","ppno":2079737979,"pcpadd":"Eleanor Widener Dixon Memorial Clinic,37 Clinic Rd","pcpcity":"Gouldsboro","pcpstate":"ME","pcpzip":"04607","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE GOULDSBORO","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 32","madd2":"","madd3":"","mcity":"PROSPECT HARBOR","mstate":"ME","mzip":"04669","pcpfaxno":2079479579,"pcpnpi":1851771364,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8N41K04KE16","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G8929","M542","M9900","M9901","M9907","M9902","R9389","I2510","I10","S46212D","Z0000","I240","I209","D225","L821","L814","D485","R001","Z1231","N858","E782","Z955","Z7902","Z8742","H608X3","G4733","L538","Z789","R208","L918","L820","D1801","Z7189","R6889","M25512","Z7982","N840","Z86018","H2510","Z01419","G4730","Z01810","L298","M8589","R590","D259","Z01818"],"date":["2024-07-02","2024-02-20","2025-07-15","2025-07-15","2025-07-15","2025-07-15","2024-01-04","2025-08-20","2025-08-20","2025-01-14","2025-05-12","2024-03-04","2023-05-05","2025-05-01","2025-05-01","2025-05-01","2025-05-01","2025-08-20","2024-09-12","2023-10-02","2025-08-20","2023-08-22","2023-02-15","2023-10-02","2024-04-24","2025-09-11","2024-04-22","2024-04-22","2023-04-13","2023-04-13","2024-04-22","2023-04-13","2025-04-22","2023-10-04","2024-11-04","2023-08-22","2023-12-12","2023-07-07","2025-03-20","2023-05-11","2023-12-28","2025-08-22","2024-04-22","2024-09-12","2025-07-15","2023-10-02","2023-12-04"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","MISOPROSTOL","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","EZETIMIBE","","","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":""}]}]}