{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Constance G Dedam","gend":1,"currentgend":"","add":"18 POPLAR LN","city":"SURRY","state":"ME","zip":"04684","dob":"1950-08-06","age":"","mstatus":"","insh":"10000108606","cliId":"","pno":2074602027,"cno":"","email":"connie@interiorsbydetails.com","ename":"","eno":"","pphy":"BEAL, JENNIFER M","ppno":2079634066,"pcpadd":"PO BOX 5,","pcpcity":"MILBRIDGE","pcpstate":"ME","pcpzip":"46580585","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE GOULDSBORO","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"18 POPLAR LN","madd2":"","madd3":"","mcity":"SURRY","mstate":"ME","mzip":"04684","pcpfaxno":"","pcpnpi":1861774580,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5QJ8AP7PV22","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I351","R590","Z96641","Z0000","K219","Z789","E785","I10","Z471","N760","Z01812","M1611","R921","Z1231","R252","Z01818","I96","L089","I739","L820","M1712","H2513","G4762","R9431","H10412","N952","M7061","M7989","I77810","I6523","N6489","L986","M159","R2243","N9489","R2242","R61"],"date":["2024-12-24","2025-05-02","2025-03-12","2023-11-10","2024-03-19","2023-09-22","2025-02-18","2024-11-17","2025-02-06","2024-12-27","2024-08-21","2024-10-16","2025-08-18","2025-08-08","2025-08-08","2024-09-20","2025-08-27","2025-08-27","2023-09-20","2024-01-18","2024-01-26","2025-03-31","2024-05-01","2023-11-02","2024-12-31","2025-03-14","2023-11-10","2023-09-14","2024-12-24","2024-12-24","2025-08-18","2025-08-27","2024-08-10","2023-09-14","2025-04-11","2023-08-02","2024-12-27"],"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":[["","","METRONIDAZOLE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ROPINIROLE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","REPATHA SYRINGE","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","REPATHA SURECLICK","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FENOFIBRATE","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","FLUOCINONIDE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","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":""}]}]}