{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sharon M Dow","gend":1,"currentgend":"","add":"35 VILLAGE DRIVE","city":"CORINTH","state":"ME","zip":"04427","dob":"1958-09-04","age":"","mstatus":"","insh":"10000107806","cliId":"","pno":2075925337,"cno":"","email":"smdow3@hotmail.com","ename":"","eno":"","pphy":"FAGLES, NINA E","ppno":2079890550,"pcpadd":"84 KELLEY RD,","pcpcity":"ORONO","pcpstate":"ME","pcpzip":"44733416","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"35 VILLAGE DRIVE","madd2":"","madd3":"","mcity":"CORINTH","mstate":"ME","mzip":"04427","pcpfaxno":"","pcpnpi":1124069851,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5R26KP2AQ73","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25662","M13862","M25562","N1831","E559","Z1231","M1711","Z471","N289","M1712","M6588","L659","R7989","Z780","M170","R778","M8589","E039","K219","J302","Z96652","Z09","Z0100","H40003","S83272A","R771","I87323","G44229","L570","R102","R899","N182","E8352","R1909","D225","L821","L814","M7062","H40013","Z0000"],"date":["2024-04-11","2024-04-11","2024-04-11","2025-03-13","2025-06-03","2025-11-12","2024-10-31","2024-05-09","2024-01-25","2024-01-16","2025-03-13","2024-10-16","2023-09-06","2023-11-08","2024-10-10","2024-02-22","2023-11-08","2024-12-22","2024-05-06","2023-12-27","2025-01-29","2025-01-29","2025-09-22","2025-09-22","2023-09-28","2024-01-25","2023-08-30","2024-12-22","2025-06-03","2025-06-03","2024-01-25","2025-03-26","2025-03-26","2025-06-03","2023-11-30","2023-11-30","2023-11-30","2023-11-21","2024-03-27","2025-05-28"],"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":[["","","FLUAD 2025-2026","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","LISDEXAMFETAMINE DIMESYLATE","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHET ER","","","Select","Select",""],["","","VYVANSE","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHETAMINE","","","Select","Select",""],["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","CELECOXIB","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","FLUCELVAX QUAD 2023-2024","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","FLUCONAZOLE","","","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":""}]}]}