{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jacqueline A Starbird","gend":1,"currentgend":"","add":"PO BOX 417","city":"DOVER FOXCROFT","state":"ME","zip":"04426","dob":"1950-12-24","age":"","mstatus":"","insh":"10000122492","cliId":"","pno":2075647050,"cno":"","email":"declined@031025.com","ename":"","eno":"","pphy":"MARTINS DA SILVA, VITOR","ppno":"","pcpadd":"891 W MAIN ST,","pcpcity":"DOVER FOXCROFT","pcpstate":"ME","pcpzip":"44261059","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE DOVER FOXCROFT","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO 417","madd2":"","madd3":"","mcity":"DOVER FOXCROFT","mstate":"ME","mzip":"04426","pcpfaxno":2075644461,"pcpnpi":1477171015,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9FX2NV4RC70","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25551","M25552","G4733","D649","I959","E1165","E1140","B351","H353130","Z1231","I3139","S5012XA","E113311","Z7189","I77810","I340","E113312","R9439","R0609","R5383","E113313","H43813","H26493","M7072","D472","M7071","J189","J111","R059","R6883","J101","E119","J1569","N184","N250","I2510","I259","J09X2","I5020","N179","I10","M7061","E875","I429","S40022A","W1839XA","M7989","W19XXXA"],"date":["2025-06-24","2025-06-24","2025-09-10","2025-05-15","2025-09-17","2025-07-05","2025-07-05","2025-07-05","2025-07-05","2025-09-12","2025-07-22","2025-04-19","2025-07-22","2025-03-13","2025-01-22","2025-01-22","2025-08-18","2025-01-28","2025-01-28","2025-01-28","2025-03-14","2025-07-22","2025-07-22","2025-03-21","2025-03-20","2025-06-20","2025-02-20","2025-02-20","2025-02-20","2025-02-20","2025-02-15","2025-02-26","2025-02-20","2025-05-29","2025-05-29","2025-03-06","2025-01-15","2025-02-15","2025-02-06","2025-03-06","2025-03-06","2025-04-08","2025-05-29","2025-05-20","2025-04-19","2025-04-19","2025-04-19","2025-04-19"],"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":[["","","TRESIBA FLEXTOUCH U-200","","","Select","Select",""],["","","INSULIN ASPART FLEXPEN","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","ISOSORBIDE DINITRATE","","","Select","Select",""],["","","ENALAPRIL MALEATE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","ALLOPURINOL","","","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":[]}},{"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":""}]}]}