{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Julia M Solomon","gend":1,"currentgend":"","add":"589 LITTLE MADAWASKA LAKE RD","city":"WESTMANLAND","state":"ME","zip":"04783","dob":"1954-02-03","age":"","mstatus":"","insh":"10000113287","cliId":"","pno":2075513158,"cno":"","email":"decline@2024.com","ename":"","eno":"","pphy":"ALLEY, ABIGAIL","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":"589 LITTLE MADAWASKA LAKE RD","madd2":"","madd3":"","mcity":"WESTMANLAND","mstate":"ME","mzip":"04783","pcpfaxno":2077608170,"pcpnpi":1396435632,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6AE8EN3RU66","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1211","I10","R7303","E785","K219","M79601","T8172XA","I808","Z7722","R4189","Z0101","H47323","Z1231","Z0000","R92323","Z0001","I8002"],"date":["2024-09-24","2024-09-04","2024-09-04","2024-09-04","2024-09-04","2024-09-27","2024-09-27","2024-09-27","2024-09-27","2025-03-18","2024-12-10","2024-12-10","2025-02-06","2024-09-04","2024-02-05","2025-09-09","2024-09-27"],"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":[["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ROPINIROLE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","MESALAMINE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","MESALAMINE ER","","","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":""}]}]}