{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michelle E Toothaker","gend":1,"currentgend":"","add":"2255 KENNEBEC RD","city":"NEWBURGH","state":"ME","zip":"04444","dob":"1953-05-24","age":"","mstatus":"","insh":"10000110528","cliId":"","pno":2072347169,"cno":2072177480,"email":"michellebusybee@gmail.com","ename":"","eno":"","pphy":"Quirk, Brandi","ppno":2078629400,"pcpadd":"EASTERN MAINE MEDICAL CEN,PO BOX 694","pcpcity":"HAMPDEN","pcpstate":"ME","pcpzip":"04444","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE HAMPDEN","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"2255 KENNEBEC RD","madd2":"","madd3":"","mcity":"NEWBURGH","mstate":"ME","mzip":"04444","pcpfaxno":2078629411,"pcpnpi":1861076788,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6YR8JQ9GU37","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z09","Z8673","Z87891","Z7982","G4733","Z45018","T148XXA","Z1231","M8589","M7121","M1711","D509","H2512","Z0001","R7303","M25562","M170","M25561","I6523","N390","R42","I10","Z79899","Z1211","K5730","K640","D225","L821","L814","L218","R0609","E785","Z0101","H5202","H5211","H524","H40013","H43813","Z961","R1032","I6782","D485","I480","Z7901"],"date":["2025-01-23","2025-01-23","2025-01-23","2025-01-23","2025-06-16","2025-06-03","2024-07-14","2025-03-03","2024-03-01","2024-09-19","2025-05-05","2024-05-07","2024-01-24","2024-10-03","2024-03-28","2025-05-05","2025-01-02","2025-01-02","2024-07-23","2024-05-23","2025-04-07","2025-01-16","2025-01-16","2024-10-18","2024-10-18","2024-10-18","2025-05-22","2025-05-22","2025-05-22","2025-05-22","2024-06-14","2024-03-28","2024-06-25","2024-06-25","2024-06-25","2024-06-25","2025-01-02","2024-06-25","2024-06-25","2024-05-23","2024-07-24","2024-05-23","2024-03-08","2024-03-08"],"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":[["","","CITALOPRAM HBR","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","FLUOCINONIDE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","MECLIZINE HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","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":""}]}]}