{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Bernard W Miller","gend":0,"currentgend":"","add":"758 BROADWAY UNIT 10","city":"BANGOR","state":"ME","zip":"04401","dob":"1934-07-18","age":"","mstatus":"","insh":"10000010370","cliId":"","pno":"2077450198","cno":"","email":"bkubetz@gmail.com","ename":"","eno":"","pphy":"JURGENS, PAUL J","ppno":"2079412373","pcpadd":"Northern Light 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 - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 140","madd2":"","madd3":"","mcity":"BANGOR","mstate":"ME","mzip":"04401","pcpfaxno":"2079418803","pcpnpi":"1629590484","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4M00QX0KU14","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H348120","H43811","Z961","I10","H6123","S99922A","S99912A","R202","M25572","M19072","I4891","Z87891","Z7901","G6289","F17200","G5792","G629","N401","R350","N3943","Z79899","U071","J029","S91012A","S022XXA","S3991XA","S3993XA","S199XXA","S0101XA","S299XXA","S8992XA","R918","S59902A","S0990XA","S4992XA","I491","S42202A","X58XXXA","S42292D","S2232XD","S2220XD","R1030","N390","S060X0D","R531","Z7401","T07XXXD","S42302D","R0602","S42212D","S42202D","X58XXXD","S2242XA","S060XAA","S42302A","G4733","M7989","M25512","M6281","Z741","R262","I77819","R0982","B370","L03115","M79669","R600","F17290","J181","J90","E785","M722","Z0000","I890","R059","R0981","J449","G5602","Z87828","G3184","D689","V892XXA"],"date":["2026-01-27","2026-01-27","2026-01-27","2026-02-05","2023-06-07","2023-06-12","2023-06-12","2023-08-16","2023-06-12","2023-06-12","2026-02-05","2026-01-27","2025-02-12","2024-06-26","2023-09-21","2023-10-06","2023-11-10","2023-12-07","2023-12-07","2023-12-07","2025-08-01","2023-12-26","2024-06-24","2024-01-22","2024-01-22","2024-01-22","2024-01-22","2024-01-22","2024-01-22","2024-01-23","2024-01-23","2024-01-24","2024-01-26","2024-01-22","2024-01-22","2024-01-22","2024-04-11","2024-04-12","2024-02-13","2024-02-05","2024-02-12","2024-02-14","2024-02-23","2024-02-26","2024-04-11","2024-02-03","2024-04-01","2024-11-11","2024-10-24","2024-03-25","2024-03-25","2024-03-25","2024-01-22","2024-04-12","2024-04-12","2026-03-04","2024-12-17","2024-11-11","2024-11-11","2024-11-11","2024-10-15","2024-05-20","2024-06-24","2024-06-24","2024-12-17","2025-02-18","2025-02-18","2025-01-31","2024-10-24","2024-10-24","2026-02-05","2025-08-01","2026-02-05","2024-12-18","2025-07-16","2025-07-16","2024-10-28","2024-06-26","2024-06-26","2024-09-26","2024-09-26","2024-09-26"],"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":[["","","NYSTOP","","","Select","Select",""],["","","CEFUROXIME","500 MG","","Select","Select",""],["","","AMLODIPINE","5 MG","","Select","Select",""],["","","PAROXETINE HCL","20 MG","","Select","Select",""],["","","TAMSULOSIN","0.4 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","SIMVASTATIN","20 MG","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","NIFEDIPINE","30 MG","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Cyclobenzaprine","10 MG","","Select","Select",""],["","","BUMETANIDE","1 MG","","Select","Select",""],["","","ATENOLOL","25 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","OMEPRAZOLE","20 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","Nystatin 100","","","Select","Select",""],["","","Nystatin 500","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","FLUAD QUAD","","","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":""}]}]}