{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert E Baker","gend":0,"currentgend":"","add":"10 HOBBIT WAY APT A","city":"BREWER","state":"ME","zip":"04412","dob":"1950-02-24","age":"","mstatus":"","insh":"10000039882","cliId":"","pno":"2079898927","cno":"","email":"declined@041525.com","ename":"","eno":"","pphy":"KANUMALLA, RAGHU","ppno":"2079890550","pcpadd":"Northern Light Primary Care Brewer,234 State St","pcpcity":"Brewer","pcpstate":"ME","pcpzip":"04412","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"10 HOBBIT WAY APT A","madd2":"","madd3":"","mcity":"BREWER","mstate":"ME","mzip":"04412","pcpfaxno":"2079890551","pcpnpi":"1497313696","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4UK8N42PC67","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R6889","Z79818","C774","C7951","C61","K769","E8352","Z0000","Z8546","I10","Z1211","Z803","Z191","Z923","Z86010","Z800","K635","Z5111","L821","L814","D225","L720","L570","Z0100","L942","L538","R208","L728","R7982","M62838","E785","R7303","M50321","M47812","Z131","Z13220","Z7189","Z0001","D1801","M4802","M064","M542","M10041","L820"],"date":["2023-04-12","2024-01-04","2026-01-29","2026-01-29","2026-01-29","2023-07-20","2023-07-20","2025-10-01","2023-09-13","2024-10-09","2023-10-18","2023-09-13","2026-01-29","2023-10-12","2023-10-18","2023-10-18","2023-10-18","2026-01-29","2025-12-11","2025-12-11","2024-12-10","2024-06-05","2025-12-11","2025-07-01","2024-08-07","2024-06-05","2024-06-05","2025-12-11","2024-12-13","2024-12-18","2024-11-26","2024-11-26","2024-11-27","2025-01-29","2024-10-02","2024-10-02","2024-12-10","2024-09-25","2025-12-11","2025-01-29","2025-01-29","2024-11-26","2024-08-07","2024-08-07"],"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":[["","","CARVEDILOL","12.5 MG","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","LISINOPRIL","20 MG","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","25 MG","","Select","Select",""],["","","PREDNISONE","5 MG","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","BACLOFEN","10 MG","","Select","Select",""],["","","FLUAD QUAD","","","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":""}]}]}