{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gail G Chamberlin","gend":1,"currentgend":"","add":"14 CHAMBERLIN DR","city":"DEER ISLE","state":"ME","zip":"04627","dob":"1947-02-21","age":"","mstatus":"","insh":"10000015420","cliId":"","pno":"2073482581","cno":"","email":"","ename":"","eno":"","pphy":"FUSCO, ANTHONY L","ppno":"2073672311","pcpadd":"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 - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 750","madd2":"","madd3":"","mcity":"DEER ISLE","mstate":"ME","mzip":"04627","pcpfaxno":"2073672805","pcpnpi":"1396157376","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1T04M76KE72","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H40033","D3142","H527","D3132","H43393","Z23","Z0000","Z1231","M810","R630","G309","R6889","R350","M48061","M5127","M5136","M47816","R197","M5450"],"date":["2023-07-12","2023-07-12","2023-04-06","2024-07-16","2023-07-12","2023-07-13","2023-09-01","2023-10-20","2024-03-20","2023-10-24","2024-04-15","2023-12-05","2024-01-15","2024-02-24","2024-02-24","2024-02-24","2024-05-06","2024-02-15","2024-02-24"],"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",""],["","","Famotidine","","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Alendronate","70 MG","","Select","Select",""],["","","Diclofenac Sod","75 MG","","Select","Select",""],["","","Mometasone 0.1 % Lotion Padagis","","","Select","Select",""],["","","Memantine","10 MG","","Select","Select",""],["","","Arexvy","","","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":""}]}]}