{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Thomas E Blair","gend":0,"currentgend":"","add":"25 RIGHT OF WAY RD","city":"BAR HARBOR","state":"ME","zip":"04609","dob":"1948-11-02","age":"","mstatus":"","insh":"10000028283","cliId":"","pno":"2076109830","cno":"","email":"trblair48@yahoo.com","ename":"","eno":"","pphy":"RENSENBRINK, KATHRYN","ppno":"2076647780","pcpadd":"Northern Light Primary Care Ellsworth,32 Resort Way","pcpcity":"Ellsworth","pcpstate":"ME","pcpzip":"04605","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"25 RIGHT OF WAY RD","madd2":"","madd3":"","mcity":"BAR HARBOR","mstate":"ME","mzip":"04609","pcpfaxno":"2076647721","pcpnpi":"1124067194","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3FV0J27HC26","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z5181","Z7901","J449","B349","R9720","N401","R3915","R350","H43811","M1711","M25561","Z98890","I6523","I739","I10","L600","Z23","Z79899","Z0000"],"date":["2024-07-02","2023-09-11","2023-05-18","2023-05-18","2023-08-22","2023-08-22","2023-08-22","2023-08-22","2023-09-18","2024-06-07","2024-06-07","2023-10-25","2023-10-25","2023-10-25","2024-01-02","2023-11-13","2023-11-13","2023-12-20","2023-12-20"],"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":[["","","Jantoven","","","Select","Select",""],["","","Warfarin","5 MG","","Select","Select",""],["","","Lorazepam","0.5 MG","","Select","Select",""],["","","Nitrofurantoin Macro\/Mono","100 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Clotrim\/Betameth Diprop 1\/0.05 % Cream Fou","","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Dutasteride","0.5 MG","","Select","Select",""],["","","Tamsulosin","0.4 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Methadone","10 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Lisinopril","40 MG","","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":""}]}]}