{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Brenda S King","gend":1,"currentgend":"","add":"38 DRUMMOND RD","city":"Augusta","state":"ME","zip":"04330","dob":"1948-01-11","age":"","mstatus":"","insh":"10000033113","cliId":"","pno":"2075473725","cno":"","email":"declined@03212026.com","ename":"","eno":"","pphy":"FITZPATRICK, JENNIFER","ppno":"","pcpadd":"Sebasticook Valley Health,80 Main St","pcpcity":"Unity","pcpstate":"ME","pcpzip":"49883732","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HEALTH CENTER UNITY","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"38 DRUMMOND RD","madd2":"","madd3":"","mcity":"Augusta","mstate":"ME","mzip":"04330","pcpfaxno":"","pcpnpi":"1285485912","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5UJ0N44WW13","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E039","M25552","Z79890","E1140","F0393","E890","Z8639","K219","E1165","Z0101","E119","D649","I10","E785","Z122","Z87891","Z716","F17211","I2510","E041","Z7984","I70208","R0600","F32A","I708","I7090"],"date":["2023-07-19","2023-09-25","2024-02-21","2023-06-09","2024-04-16","2024-03-21","2023-08-23","2023-08-23","2024-03-21","2023-12-27","2024-03-14","2023-09-26","2024-04-30","2024-03-21","2024-01-02","2024-01-02","2023-12-12","2023-12-12","2024-05-24","2024-02-21","2024-03-14","2024-03-04","2024-04-30","2024-04-16","2024-04-02","2024-04-30"],"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":[["","","Sucralfate","1 GM","","Select","Select",""],["","","Freestyle Lite","","","Select","Select",""],["","","Levothyroxine","200 MCG","","Select","Select",""],["","","Potassium Cl","20 MEQ","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Sertraline","100 MG","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Famotidine","40 MG","","Select","Select",""],["","","Freestyle","","","Select","Select",""],["","","Januvia","","","Select","Select",""],["","","Jardiance","","","Select","Select",""],["","","Amlodipine","5 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":""}]}]}