{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dale S Thibodeau","gend":1,"currentgend":"","add":"1461 STILLWATER AVE","city":"BANGOR","state":"ME","zip":"04401","dob":"1957-08-10","age":"","mstatus":"","insh":"10000111410","cliId":"","pno":2079926997,"cno":"","email":"dsthibodeau1@gmail.com","ename":"","eno":"","pphy":"GRISSOM, AMBER N","ppno":"","pcpadd":"Northern Light Internal Medicine,302 Husson Ave Ste 1","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1461 STILLWATER AVE","madd2":"","madd3":"","mcity":"BANGOR","mstate":"ME","mzip":"04401","pcpfaxno":2079735042,"pcpnpi":1689177867,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9CU8D99PQ26","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E119","Z1211","D120","D123","D125","M48061","H40011","M4316","M48062","Z0101","H5203","M5417","M25562","W19XXXA","K5900","Z1231","N3090","F331","F411","Z853","Z79899","M79671","M79672","L851","M4322","R011","M4802","M5030","M47812","M4312","M4726","M5450","Z124","N950","B3732","C50112","Z9289","S8002XA","Z23","W01198A","Y92007","G8929","G8918","Z981","Z01818","C50912","R5383","Z08","Z803","Z923","M5416","G6289","N952","Z13220","M21372","E559","M5117","M4727","M5136","M47816","E11620","M159"],"date":["2025-09-08","2025-07-03","2025-07-03","2025-07-03","2025-07-03","2025-04-18","2024-07-15","2025-07-22","2025-07-22","2025-09-08","2025-09-08","2025-04-29","2025-07-08","2025-07-08","2025-07-27","2025-07-07","2024-04-08","2024-06-03","2024-04-01","2025-08-01","2024-04-01","2025-03-24","2025-03-24","2025-03-24","2025-06-26","2025-07-17","2025-06-26","2025-06-26","2025-06-26","2025-06-26","2024-01-24","2025-07-27","2025-04-16","2025-04-16","2025-04-16","2025-04-16","2025-04-16","2025-07-08","2025-07-08","2025-07-08","2025-07-08","2025-07-27","2025-07-27","2025-09-11","2025-06-16","2023-12-04","2024-04-01","2025-08-01","2025-08-01","2025-08-01","2024-01-26","2024-01-26","2025-04-16","2025-01-10","2025-09-11","2023-12-04","2024-01-24","2024-01-24","2024-01-24","2024-01-24","2024-04-11","2024-04-11"],"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":[["","","FLUCONAZOLE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","CLINDAMYCIN-BENZOYL PEROXIDE","","","Select","Select",""],["","","CLINDAMYCIN PHOSPHATE","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","ONETOUCH ULTRASOFT 2 LANCET","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","ONETOUCH ULTRA2","","","Select","Select",""],["","","TRAMADOL 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":{"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":[]}]},{"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":""}]}]}