{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan L Daley","gend":1,"currentgend":"","add":"30 GLEN RD","city":"Yarmouth","state":"ME","zip":"04096","dob":"1958-03-10","age":"","mstatus":"","insh":"10000038779","cliId":"","pno":"2078465260","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":"30 GLEN RD","madd2":"","madd3":"","mcity":"Yarmouth","mstate":"ME","mzip":"04096","pcpfaxno":"2075351249","pcpnpi":"1114339611","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5DG2JE8GX01","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1231","R32","E119","I10","Z0001","I890","E782","Z23","L03116","L03115","Z741","G894","F1120","M25511","I5033","L97821","F1123","E6601","Z98890","R000","F17210","T40601S","G8929","M5450","I5032","R948","M19011","S81801D","R531","G9340","I509","L97909","I130","H6123","N179","E1121","Z136","G9341","R0602","R079","M7541","G9389","I5030","I959","N170","E871","S81801A","J9692","R262","J9690","R600","I499","B351","J9601","J9602","N178","I9589","J9600","K5900","N3289","R790","J90","G928","A000","R932","Z736"],"date":["2023-04-20","2023-04-20","2025-12-16","2025-09-16","2023-08-04","2025-07-30","2023-08-04","2025-03-09","2024-12-18","2024-05-06","2024-05-29","2025-09-08","2025-09-08","2025-09-23","2025-06-04","2025-02-10","2025-07-21","2025-03-12","2024-10-01","2025-07-21","2025-07-21","2025-05-29","2025-05-29","2025-07-08","2025-09-16","2025-06-13","2025-09-23","2024-08-14","2025-05-04","2025-05-29","2025-06-05","2025-01-17","2025-07-04","2025-06-03","2025-05-06","2025-05-23","2025-07-21","2025-05-04","2025-03-08","2025-03-08","2025-10-29","2025-03-09","2025-05-20","2025-05-05","2025-05-20","2025-05-06","2024-08-12","2025-05-29","2025-05-29","2025-05-04","2024-08-12","2025-05-04","2025-05-23","2025-05-05","2025-05-05","2025-05-05","2025-05-05","2025-05-04","2025-05-04","2025-05-04","2025-12-16","2025-05-09","2025-05-26","2024-08-14","2025-05-05","2025-05-26"],"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",""],["","","BELBUCA","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","CARVEDILOL","25 MG","","Select","Select",""],["","","AMLODIPINE","5 MG","","Select","Select",""],["","","Potassium Cl","750 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","MORPHINE","30 MG","","Select","Select",""],["","","METOPROLOL SUCC","200 MG","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","LISINOPRIL","40 MG","","Select","Select",""],["","","OXYBUTYNIN","5 MG","","Select","Select",""],["","","TRAZODONE","100 MG","","Select","Select",""],["","","TORSEMIDE","20 MG","","Select","Select",""],["","","GABAPENTIN","100 MG","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","ATORVASTATIN","40 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","BACLOFEN","10 MG","","Select","Select",""],["","","POTASSIUM CL (","750 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":""}]}]}