{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Morris Brann","gend":0,"currentgend":"","add":"678 TODDS CORNER ROAD","city":"SAINT ALBANS","state":"ME","zip":"04971","dob":"1956-03-30","age":"","mstatus":"","insh":"10000104495","cliId":"","pno":2079387123,"cno":"","email":"declined@121824.com","ename":"","eno":"","pphy":"BADEEN, STEVEN J","ppno":2073684292,"pcpadd":"100 Main St,","pcpcity":"Newport","pcpstate":"ME","pcpzip":"04953","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE NEWPORT","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"678 TODDS CORNER ROAD","madd2":"","madd3":"","mcity":"SAINT ALBANS","mstate":"ME","mzip":"04971","pcpfaxno":"","pcpnpi":1801984471,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9U15X07HK60","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J90","R0989","I517","S2249XA","C9000","I2510","I214","Z5112","E1165","I779","S91201D","D759","R897","Z09","J14","J951","N170","S0590XA","I252","L603","Z5111","N1830","R918","D472","E1142","F17220","J9811","R809","D649","S91201A","W19XXXA","I255","E1122","N189","D631","I5020","M159","R531","L309","S0990XA","R42","Z4509","Z48812","Z4682","I454","S91209A","Z01810","I6523","M7989","I4729","J939","Z951","I10","Z98890","N179","E8720","E8351","I080","M79671","R7989","Z0001","R937","Z5321","E6601","E119","R911","R600","B349","I129","J9601","J4551","Z452","I3481","I25810"],"date":["2025-09-30","2023-05-06","2023-07-10","2023-05-06","2025-10-16","2025-11-08","2025-01-28","2025-09-22","2025-11-13","2023-11-16","2023-11-20","2023-09-21","2023-03-07","2025-01-08","2023-01-27","2023-01-27","2023-01-27","2024-12-30","2025-11-12","2025-08-01","2023-08-03","2025-05-05","2025-06-19","2023-03-16","2024-09-23","2025-01-13","2023-01-24","2023-02-16","2023-05-06","2023-11-03","2023-11-03","2025-11-03","2025-08-07","2025-08-25","2025-08-25","2025-11-12","2023-12-06","2023-07-19","2023-01-07","2023-01-08","2023-01-08","2025-04-23","2023-02-27","2023-01-20","2023-06-08","2023-11-07","2023-01-12","2023-07-19","2023-05-08","2025-04-23","2023-01-18","2025-02-04","2023-07-19","2024-03-25","2023-01-23","2023-01-23","2023-01-23","2023-01-13","2023-11-13","2023-01-20","2025-04-30","2023-02-27","2025-02-15","2023-01-09","2023-09-21","2025-06-02","2023-05-06","2025-02-18","2023-12-06","2023-01-10","2023-01-10","2023-01-14","2023-07-10","2023-01-28"],"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":[["","","ENTRESTO","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","ACYCLOVIR","","","Select","Select",""],["","","DEXCOM G6 SENSOR","","","Select","Select",""],["","","DEXCOM G6 TRANSMITTER","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","SACUBITRIL-VALSARTAN","","","Select","Select",""],["","","ULTRA-FINE NANO PEN NEEDLE","","","Select","Select",""],["","","DEXAMETHASONE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","UNIFINE PENTIPS PLUS","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","LOPERAMIDE","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","GLUCOCARD VITAL","","","Select","Select",""],["","","DEXCOM G6 RECEIVER","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","SEMGLEE (YFGN) PEN","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","INSUPEN PEN NEEDLE","","","Select","Select",""],["","","SEMGLEE (YFGN)","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}