{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ronald L Carpenter","gend":0,"currentgend":"","add":"133 E SIDE RD","city":"ADDISON","state":"ME","zip":"04606","dob":"1938-06-18","age":"","mstatus":"","insh":"10000029210","cliId":"","pno":"4058340012","cno":"4058340012","email":"timcarp@flash.net","ename":"","eno":"","pphy":"CROWLEY, KERRY W","ppno":"2079634066","pcpadd":"50 UNION ST,ELEANOR WIDENER DIXON MEMORIAL CLINIC","pcpcity":"ELLSWORTH","pcpstate":"ME","pcpzip":"46051586","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE GOULDSBORO","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1208 SW 92ND ST","madd2":"","madd3":"","mcity":"OKLAHOMA CITY","mstate":"OK","mzip":"73139","pcpfaxno":"2079637723","pcpnpi":"1679511075","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7N04WY7FE72","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I6523","R29898","Z8673","I2510","I119","E785","N1830","W19XXXA","I10","I7143","Z48812","I7140","I9789","I4891","M25562","R2689","J811","Y9301","I252","Z98890","I255","I082","I2720","Z23","R55","Z85528","Z0000","Z7189","Z1211","Z125","M79671","L84","Z7982","N401","R351","N138","N3289","R5381","M79604","S299XXA","R0781","R0789","H40013"],"date":["2023-04-21","2023-04-21","2023-04-21","2023-10-23","2023-04-21","2023-04-21","2023-09-11","2023-09-11","2023-10-23","2023-09-20","2023-06-05","2023-06-05","2023-10-23","2023-06-26","2023-08-29","2024-05-15","2023-08-30","2023-08-30","2023-09-11","2023-09-20","2023-09-21","2023-10-09","2023-10-09","2024-02-28","2023-12-30","2024-01-18","2024-02-28","2024-02-28","2024-02-28","2024-02-28","2024-04-02","2024-04-11","2024-04-11","2024-02-28","2024-02-28","2024-02-28","2024-02-28","2024-05-15","2024-05-15","2024-06-03","2024-06-03","2024-06-07","2024-07-11"],"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":[["","","Potassium Cl","750 MG","","Select","Select",""],["","","Alfuzosin","10 MG","","Select","Select",""],["","","Lisinopril","10 MG","","Select","Select",""],["","","Mnexspike","","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Furosemide","20 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":""}]}]}