{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Wilbur C Cotton","gend":0,"currentgend":"","add":"1242 Main Rd","city":"Eddington","state":"ME","zip":"04428","dob":"1942-05-10","age":"","mstatus":"","insh":"10000126049","cliId":"","pno":2077453952,"cno":"","email":"","ename":"","eno":"","pphy":"Grebliunaite, Ruta","ppno":2079412373,"pcpadd":"Emmc Husson Family Medicine,302 Husson Ave Ste 2","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HUSSON FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"Po Box 190","madd2":"","madd3":"","mcity":"Eddington","mstate":"ME","mzip":"04428","pcpfaxno":2079418803,"pcpnpi":1922487412,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8UH5YA2QE78","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C601","C609","I2510","T8141XA","Z4509","Z48816","R197","Z4800","C220","Z466","I493","T8131XA","R339","M868X7","D649","Z483","M21161","M76821","Z08","S3120XD","K224","J8410","J929","K7460","R410","Z8549","K828","M19071","S0990XA","R161","Z7982","N1830","Z9079","I5032","I10","M869"],"date":["2025-01-04","2025-06-17","2025-05-01","2025-02-27","2025-05-15","2025-05-16","2025-05-14","2025-05-27","2025-06-06","2025-06-03","2025-05-13","2025-06-09","2025-02-13","2025-02-21","2025-06-04","2025-04-11","2025-01-09","2025-01-09","2025-01-03","2025-03-10","2025-04-17","2025-04-15","2025-04-15","2025-04-17","2025-03-02","2025-04-15","2025-04-15","2025-01-21","2025-02-27","2025-04-18","2025-02-14","2025-03-31","2025-03-31","2025-03-31","2025-03-31","2025-01-09"],"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":[["","","SILODOSIN","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","ROPINIROLE HCL","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","LOKELMA","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","KLAYESTA","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","NYAMYC","","","Select","Select",""],["","","HALOPERIDOL LACTATE","","","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":{"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":""}]}]}