{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rickie N Sinclair","gend":0,"currentgend":"","add":"100 EAST SIDE RD","city":"HANCOCK","state":"ME","zip":"04640","dob":"1959-07-19","age":"","mstatus":"","insh":"10000115034","cliId":"","pno":2076649477,"cno":"","email":"","ename":"","eno":"","pphy":"KOLISCH, ANITA D","ppno":2076647780,"pcpadd":"32 RESORT WAY,","pcpcity":"ELLSWORTH","pcpstate":"ME","pcpzip":"46051717","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"100 EAST SIDE RD","madd2":"","madd3":"","mcity":"HANCOCK","mstate":"ME","mzip":"04640","pcpfaxno":2076647721,"pcpnpi":1447283981,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5X74PN3RX03","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","Z713","Z1211","I10","E871","M5432","M5459","D122","D124","D123","K5730","R030","Z79899","Z87891","N401","R351","M5450","M25561","R7303","M1712","R519","N281","Z0000","Z85038","R079","Z139","Z7689","K219","I4510","C184","Z860101","Z0130","F419","N529","I160","G4736","R350","M25562","R0602","R9720","M1711","H5213","Z0101","R4182"],"date":["2025-09-04","2024-12-16","2024-10-29","2025-08-20","2025-02-06","2024-08-08","2024-10-09","2025-03-25","2025-03-25","2025-03-25","2025-03-25","2024-10-07","2025-05-23","2025-04-29","2025-05-23","2025-05-23","2024-11-06","2024-07-24","2025-03-17","2024-08-14","2024-08-13","2024-10-11","2025-07-25","2024-11-13","2024-08-25","2024-08-14","2024-07-24","2024-07-24","2025-08-20","2025-04-29","2025-04-29","2025-09-03","2025-07-25","2025-02-06","2024-08-08","2024-12-06","2024-08-13","2024-08-23","2024-08-12","2025-05-23","2024-07-24","2025-01-23","2025-01-23","2024-08-09"],"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":[["","","MOVIPREP","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","PEG3350-SOD SUL-NACL-KCL-ASB-C","","","Select","Select",""],["","","VENLAFAXINE HCL ER","","","Select","Select",""],["","","LABETALOL 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":[]}},{"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":""}]}]}