{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kristi T Tilley","gend":1,"currentgend":"","add":"77 BOUNDARY LINE RD","city":"BRIDGEWATER","state":"ME","zip":"04735","dob":"1958-09-08","age":"","mstatus":"","insh":"10000111403","cliId":"","pno":2072274634,"cno":"","email":"","ename":"","eno":"","pphy":"MURPHY, TIERNAN P","ppno":2077643142,"pcpadd":"Northern Light Primary Care Presque Isle,23 North St Ste 4","pcpcity":"Presque Isle","pcpstate":"ME","pcpzip":"04769","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE PRESQUE ISLE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"77 BOUNDARY LINE RD","madd2":"","madd3":"","mcity":"BRIDGEWATER","mstate":"ME","mzip":"04735","pcpfaxno":2077608170,"pcpnpi":1821583253,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6XH8G70FN25","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1165","Z1211","K7460","D120","D122","D125","R319","R109","K640","Z87891","K4020","Z87440","M47812","B029","K760","F1090","I8510","K766","Z1231","M549","R3989","R350","K029","K7581","R92323","E119","R7303","K8020","R161","Z1289","K7400","R932"],"date":["2025-08-25","2025-05-07","2025-10-24","2024-10-23","2025-05-07","2024-10-23","2024-04-02","2024-04-10","2025-05-07","2025-05-07","2024-05-07","2024-04-10","2025-05-20","2024-02-17","2024-07-26","2024-07-26","2025-10-24","2025-10-24","2025-09-02","2024-02-17","2024-04-02","2024-04-02","2024-08-30","2024-05-17","2025-09-02","2025-05-23","2025-05-20","2024-08-09","2024-04-19","2025-10-06","2024-05-17","2024-05-07"],"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":[["","","LANCETS","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-100","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","VALACYCLOVIR","","","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":""}]}]}