{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Raymond A Daigle","gend":0,"currentgend":"","add":"39 VICTOR LN","city":"CLINTON","state":"ME","zip":"04927","dob":"1946-11-20","age":"","mstatus":"","insh":"10000040713","cliId":"","pno":"2074266014","cno":"","email":"declined@021825.com","ename":"","eno":"","pphy":"BARATTA, ELIZABETH A","ppno":"2079737979","pcpadd":"Northern Light Family Medicine and Residency,895 Union St Ste 12","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE CLINTON","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"2076806254","add2":"","add3":"","madd1":"39 VICTOR LN","madd2":"","madd3":"","mcity":"CLINTON","mstate":"ME","mzip":"04927","pcpfaxno":"2079479579","pcpnpi":"1740718261","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3G25TX4JV87","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I69354","I639","I10","Z7689","R001","Z743","I455","I4430","I4820","I4891","I493","I081","Z952","Z8673","E11319","E119","Z7409","E039","E118","R300","Z950","Z45018","I69398","I2510","R55","G4089","R400","T82190A","Y831","E1151","D649","D72828","D72829","I6523","I6501","G9389","I63511","R202","R569","I672","T426X6A","Z23","I6389","G40909","R42","R4182","D6859","E1142","I350","Z954","N400","Z125","Z139","Z0000","Z1331","Z1389","E785","M546","M25552","W08XXXD","M5134","M25512","M19012","R739","Z79899","I2119","B351","R0600","R0789","Z043","Z89512","Z9189","R7989","R918","J90","R079","I700","I119","D6869","M6281","I69992","D72821","D696","I422","I5030","I082","Z953","I619","R4781","I4811","Z006","I708","K551","I748"],"date":["2023-04-14","2025-11-07","2025-07-20","2023-04-13","2023-10-05","2025-10-15","2023-04-30","2023-05-17","2023-05-17","2023-10-11","2023-04-19","2024-05-31","2024-05-17","2023-06-02","2023-06-02","2025-05-31","2023-04-25","2025-05-23","2024-05-31","2023-06-08","2025-05-15","2023-12-08","2026-01-27","2025-05-15","2025-08-06","2023-07-12","2023-07-12","2023-07-17","2023-07-17","2025-12-09","2023-10-04","2023-09-15","2023-09-15","2023-10-05","2023-10-05","2023-10-11","2023-10-05","2023-10-05","2023-10-11","2023-10-11","2023-10-11","2024-11-07","2023-10-18","2026-01-27","2023-10-05","2025-08-06","2023-11-21","2023-11-20","2024-05-31","2024-05-17","2024-05-14","2024-05-14","2025-05-23","2025-07-20","2025-05-23","2025-05-23","2024-05-31","2024-12-30","2025-11-07","2025-11-07","2024-12-30","2025-03-04","2025-03-04","2025-08-06","2026-01-27","2025-05-31","2024-11-20","2025-12-09","2025-05-15","2024-12-30","2025-03-04","2025-03-04","2025-12-09","2025-12-09","2025-12-09","2025-05-15","2025-05-15","2024-09-20","2024-09-20","2025-10-15","2025-10-15","2023-03-01","2023-03-01","2023-02-27","2023-02-27","2023-02-27","2023-02-27","2023-02-27","2023-02-27","2023-03-17","2023-02-15","2023-01-17","2023-01-17","2023-01-17"],"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":[["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","DOXAZOSIN","2 MG","","Select","Select",""],["","","Freestyle Libre 14 Day Reader (Ref 71938-0","","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","FINASTERIDE","5 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","LEVOTHYROXINE","25 MCG","","Select","Select",""],["","","ATORVASTATIN","80 MG","","Select","Select",""],["","","AMLODIPINE","10 MG","","Select","Select",""],["","","LEVETIRACETAM","500 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","Freestyle Libre 14 Day Sensor (Ref 71940-0","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","LOSARTAN","50 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","Ketorolac 0.5 % Ophth Sol Apotex","","","Select","Select",""],["","","ACARBOSE","25 MG","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","TIZANIDINE","2 MG","","Select","Select",""],["","","HYDROCODONE\/ACETAMINOPHEN","5\/325 MG","","Select","Select",""],["","","Freestyle Libre 2 Reader (Ref 71953-01)","","","Select","Select",""],["","","Freestyle Libre 2 Sensor","","","Select","Select",""],["","","HYDRALAZINE","100 MG","","Select","Select",""],["","","ISOSORBIDE DINITRATE","30 MG","","Select","Select",""],["","","KETOROLAC","0.005","","Select","Select",""],["","","FREESTYLE LIBRE","2 READER","","Select","Select",""],["","","PREDNISOLONE ACE","0.01","","Select","Select",""],["","","COMIRNATY","","","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":""}]}]}