{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dennis C Ramos","gend":0,"currentgend":"","add":"205 BUNKER HILL RD","city":"MAXFIELD","state":"ME","zip":"04453","dob":"1948-10-10","age":"","mstatus":"","insh":"10000027737","cliId":"","pno":"2077325555","cno":"2079436631","email":"PAT01@MIDMAINE.COM","ename":"","eno":"","pphy":"FAGLES, NINA E","ppno":"2079890550","pcpadd":"84 KELLEY RD,","pcpcity":"ORONO","pcpstate":"ME","pcpzip":"44733416","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"205 BUNKER HILL RD","madd2":"","madd3":"","mcity":"MAXFIELD","mstate":"ME","mzip":"04453","pcpfaxno":"","pcpnpi":"1124069851","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4HP1JC9MQ01","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H833X3","H9113","E538","M1712","Z96651","M48061","M47816","Z791","Z79899","G4733","M5127","M47817","M4316","M5136","H40053","Z0101","H52223","R6889","E785","D649","Z0000","I77811","E6601","Z7982","Z6835","E871","E875","I700","Z1211","Z1212","D123","K5730","Z87438","H6123","M47819","Z48811","Z09"],"date":["2023-04-14","2023-04-14","2023-09-26","2023-04-14","2024-06-20","2024-03-26","2024-05-28","2023-05-09","2023-05-09","2024-04-22","2023-06-24","2023-06-24","2024-05-28","2024-05-28","2024-03-06","2023-08-30","2023-08-30","2023-09-11","2023-09-26","2023-09-26","2023-09-26","2023-11-16","2023-09-26","2023-09-26","2023-09-26","2024-03-29","2023-11-16","2023-11-16","2023-12-01","2023-12-01","2023-12-01","2023-12-01","2024-01-12","2024-03-06","2024-05-14","2024-05-28","2024-06-20"],"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":[["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Simvastatin","40 MG","","Select","Select",""],["","","Ibuprofen","600 MG","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Prevnar 20","","","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":""}]}]}