{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John F Collora","gend":0,"currentgend":"","add":"269 WILSON DISTRICT RD","city":"HARRINGTON","state":"ME","zip":"04643","dob":"1971-10-02","age":"","mstatus":"","insh":"10000107576","cliId":"","pno":2075988808,"cno":"","email":"collora71@gmail.com","ename":"","eno":"","pphy":"KOLISCH, ANITA D","ppno":2076647780,"pcpadd":"32 RESORT WAY,","pcpcity":"ELLSWORTH","pcpstate":"ME","pcpzip":"46051717","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"269 WILSON DISTRICT RD","madd2":"","madd3":"","mcity":"HARRINGTON","mstate":"ME","mzip":"04643","pcpfaxno":2076647721,"pcpnpi":1447283981,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2XM7AT6EH64","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5450","M25552","M25551","F411","D7589","R836","M9903","M9904","M9905","M9906","H61112","R930","S00432A","R002","Z7189","G939","M5116","M47812","W228XXA","Z87891","R21","G9389","R9389","Z87898","M1990","R55","R0609","I77819","S73192A","X58XXXA","Y939","Y929","M79652","M1712","R0600","M5417","I10","R9082","L089","L578","I110","I5022","F1010","G4733","G894","M5418","M24152","M1612","Z48810","M9900","M9901","M9902","R519","R748","R109","D696","Z01812","M47816","M461","F17220","M25569","M1711","Z471","Z96651","M25562","A7749","H02403","H53453","R197","M7918","B179","R2242","E871","R079","R2689","R42","I209","Z0000","I428","I6523","E785","F418","N529","M23321","M5136","M5126","M48061","K219","F419","M23331","M25461","Z96659","M160","S0990XA","E8342","Z882","M7742","I4710","M79672","K7689","H40013","F413","R0602","I340","G834"],"date":["2025-08-06","2025-08-06","2025-08-06","2025-08-11","2025-05-20","2025-05-20","2025-08-14","2025-08-14","2025-08-14","2025-08-14","2025-08-25","2025-08-05","2025-07-15","2025-08-13","2025-09-12","2025-09-12","2025-09-12","2025-09-12","2025-07-15","2025-08-25","2025-08-12","2025-05-12","2025-05-01","2025-08-13","2024-07-09","2025-05-30","2025-08-13","2025-08-13","2024-05-24","2024-05-24","2024-05-24","2024-05-24","2024-06-05","2025-04-25","2024-05-11","2025-05-30","2025-05-30","2025-09-05","2025-08-25","2025-08-25","2025-05-05","2025-05-05","2024-05-28","2025-02-14","2025-07-10","2024-07-24","2024-05-20","2024-05-20","2025-09-03","2025-07-10","2025-07-10","2025-07-10","2025-08-05","2023-07-06","2023-06-30","2023-06-30","2023-10-20","2025-02-25","2025-02-25","2025-02-25","2025-02-25","2023-10-23","2024-11-08","2024-11-08","2025-04-25","2023-08-08","2024-01-08","2024-01-08","2023-06-23","2023-06-20","2023-06-26","2024-10-25","2024-12-10","2025-01-28","2024-12-03","2024-12-03","2025-02-19","2023-06-06","2025-02-19","2024-03-05","2024-03-05","2023-06-06","2023-06-06","2023-06-15","2024-08-26","2024-08-26","2024-08-26","2023-10-23","2023-10-23","2023-06-09","2023-06-09","2023-11-01","2024-02-20","2025-02-03","2025-01-30","2025-01-30","2023-07-19","2025-01-28","2023-07-19","2023-07-24","2023-12-06","2023-12-11","2024-03-22","2024-03-22","2024-11-11"],"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":[["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","NYSTOP","","","Select","Select",""],["","","ENOXAPARIN SODIUM","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","HYDROMORPHONE HCL","","","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":{"indx":[["","","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}