{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sandra J Smith","gend":1,"currentgend":"","add":"322 EAST RD","city":"BRADFORD","state":"ME","zip":"04410","dob":"1955-05-26","age":"","mstatus":"","insh":"10000103574","cliId":"","pno":2076595808,"cno":"","email":"Sjsmith404@gmail.com","ename":"","eno":"","pphy":"KANUMALLA, RAGHU","ppno":2079890550,"pcpadd":"Northern Light Primary Care Brewer,234 State St","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":"322 EAST RD","madd2":"","madd3":"","mcity":"BRADFORD","mstate":"ME","mzip":"04410","pcpfaxno":2079890551,"pcpnpi":1497313696,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1T26C30NE64","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":["N644","J208","R059","Z1211","D125","E6601","Z6835","L0291","L03311","B372","Z792","Z0001","E785","S8011XA","M5450","Z7189","Z1239","Z23","R6889","R7303","Z0000","K640","Z1231","S8991XA","Z6837","R7302","M7121","W01198A","Y939","Y9259","J0100","J069","L0390","M79661","R509","M5136","M47816","J989","I10","I082","R062","R918","J45909","F325","Z0100","H524"],"date":["2023-09-28","2024-12-26","2024-12-26","2025-05-14","2025-05-14","2025-03-13","2024-05-30","2023-11-03","2023-11-03","2023-11-03","2023-11-03","2025-08-08","2025-03-13","2025-01-16","2023-06-21","2023-01-12","2023-09-28","2024-12-17","2023-10-13","2025-03-13","2024-05-30","2025-05-14","2025-09-02","2025-01-06","2024-04-24","2023-02-07","2025-01-06","2025-01-16","2025-01-16","2025-01-16","2025-06-01","2023-07-20","2023-10-27","2024-09-06","2023-07-20","2023-06-21","2023-06-21","2023-08-09","2025-04-15","2025-04-15","2023-08-09","2023-08-09","2023-05-04","2023-05-04","2023-10-13","2023-10-13"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","BACLOFEN","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AREXVY","","","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":""}]}]}