{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Barbara Wentworth","gend":1,"currentgend":"","add":"404 LAWRENCE RD","city":"Pownal","state":"ME","zip":"04069","dob":"1947-04-08","age":"","mstatus":"","insh":"10000017402","cliId":"","pno":"2076884408","cno":"","email":"","ename":"","eno":"","pphy":"NEWCOMBE, JODI A","ppno":"2075351200","pcpadd":"385 ROUTE 1,","pcpcity":"YARMOUTH","pcpstate":"ME","pcpzip":"40966729","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE YARMOUTH","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"404 LAWRENCE RD","madd2":"","madd3":"","mcity":"Pownal","mstate":"ME","mzip":"04069","pcpfaxno":"2075351249","pcpnpi":"1114339611","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1GK5AN7CF71","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H401130","H2513","E119","E673","M2550","E113219","E1129","Z79899","H2512","M25552","H401120","Z96642","H2511","L03012","Z1231","L0390","H401110","H4010X4","E113293","H43813","H409","Z0000","E1165","I10","Z853","H11821","H401132","M9901","M542","M9905","M533","L299"],"date":["2023-05-10","2023-05-10","2023-06-20","2023-06-20","2023-06-20","2023-11-09","2023-06-20","2023-07-17","2023-07-18","2023-07-19","2023-07-18","2023-07-19","2023-08-01","2023-08-10","2023-08-10","2023-08-10","2023-08-01","2023-07-18","2024-05-17","2023-11-13","2023-12-19","2023-11-09","2024-05-09","2023-11-09","2023-11-09","2024-05-01","2024-05-17","2024-07-01","2024-07-01","2024-07-01","2024-07-01","2024-06-10"],"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":[["","","Atorvastatin","20 MG","","Select","Select",""],["","","Doxycycline Monohydrate","100 MG","","Select","Select",""],["","","Escitalopram","20 MG","","Select","Select",""],["","","Metformin Hcl Er","","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Mounjaro","","","Select","Select",""],["","","Capvaxive","","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Pramipexole","1 MG","","Select","Select",""],["","","Alendronate","70 MG","","Select","Select",""],["","","Amlodipine","10 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Glipizide","5 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","Twinrix","","","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":""}]}]}