{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Diane Hardie","gend":1,"currentgend":"","add":"169 PEREZ CROSSROAD","city":"DEER ISLE","state":"ME","zip":"04627","dob":"1959-03-17","age":"","mstatus":"","insh":"10000114733","cliId":"","pno":2073486117,"cno":"","email":"Hardie_diane@yahoo.com","ename":"","eno":"","pphy":"COBB, TIMOTHY A","ppno":2073672311,"pcpadd":"Northern Light Primary Care Stonington,354 Airport Rd","pcpcity":"Stonington","pcpstate":"ME","pcpzip":"04681","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE STONINGTON","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 7","madd2":"","madd3":"","mcity":"SUNSET","mstate":"ME","mzip":"04683","pcpfaxno":2073672805,"pcpnpi":1326557372,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2CJ0JY0UF39","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1165","Z5181","H81399","I4891","Z7901","E785","E119","E559","Z0000","R0602","I480","R42","Z1389","Z23","R002","Z1231","I081","I351","I77810","E8342","I10","H903","Z0101","H40013","S93602A","I517","W109XXA","M19072","R079"],"date":["2025-07-07","2025-06-04","2025-01-14","2025-07-24","2025-07-03","2025-04-16","2025-03-04","2024-10-08","2025-04-09","2025-04-16","2025-07-17","2025-01-15","2025-09-08","2024-10-15","2024-11-17","2024-04-01","2025-06-05","2024-05-20","2024-05-20","2024-04-07","2024-11-17","2025-08-15","2024-11-06","2024-11-06","2024-08-30","2024-12-03","2024-08-30","2024-08-30","2024-11-02"],"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":[["","","INSULIN ASPART FLEXPEN","","","Select","Select",""],["","","TOUJEO SOLOSTAR","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","INSULIN DEGLUDEC","","","Select","Select",""],["","","REPAGLINIDE","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","ULTRA-FINE NANO PEN NEEDLE","","","Select","Select",""],["","","PRADAXA","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","DABIGATRAN ETEXILATE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}