{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Raymond L Gustafson","gend":0,"currentgend":"","add":"25 FREMONT ST","city":"BANGOR","state":"ME","zip":"04401","dob":"1952-09-20","age":"","mstatus":"","insh":"10000038872","cliId":"","pno":"2079477244","cno":"","email":"declined@040425.com","ename":"","eno":"","pphy":"OCONNELL, KRISTOPHER L","ppno":"","pcpadd":"43 WHITING HILL RD,SUITE 300","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121005","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE HAMPDEN","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"25 FREMONT ST","madd2":"","madd3":"","mcity":"BANGOR","mstate":"ME","mzip":"04401","pcpfaxno":"2079735042","pcpnpi":"1881993475","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6X24RN9PW50","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25511","M25512","R053","I10","R059","R918","K8020","Z1211","K635","K5730","K640","Z86010","R0602","J329","Z0001","E785","R7303","L821","L84","L259","J320","J342","B070","J0190","H6993","J029","K449","R911","H6123","T1490XA","E6601","M19072","M1712","D225","L814","B078","L570","L820","L538","R208","D485","M25562"],"date":["2023-04-03","2023-04-03","2023-04-04","2024-05-03","2024-04-23","2024-05-08","2023-06-14","2023-08-03","2023-08-03","2023-08-03","2023-08-03","2023-08-03","2023-08-15","2024-04-24","2023-09-21","2023-09-21","2023-09-21","2024-07-08","2024-03-21","2023-10-19","2024-05-08","2024-05-08","2024-03-07","2024-05-06","2024-04-19","2024-04-19","2024-04-23","2024-05-08","2024-05-06","2024-05-06","2024-05-03","2024-05-03","2024-06-28","2024-07-08","2024-07-08","2024-07-08","2024-07-08","2024-07-08","2024-07-08","2024-07-08","2024-07-08","2024-06-28"],"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":[["","","Atorvastatin","20 MG","","Select","Select",""],["","","Fluticasone Prop","50 MCG","","Select","Select",""],["","","Fluoxetine","10 MG","","Select","Select",""],["","","Amlodipine","10 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Arexvy","","","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":""}]}]}