{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Wanda B Avery","gend":1,"currentgend":"","add":"2 AVERY WAY","city":"Milford","state":"ME","zip":"04461","dob":"1950-02-28","age":76,"mstatus":"","insh":"10000040719","cliId":"","pno":"2077452266","cno":"2077452295","email":"wanda.avery1950@gmail.com","ename":"","eno":"","pphy":"KEITH, ALLISON C","ppno":"","pcpadd":"43 WHITING HILL RD,SUITE 300","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121005","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HUSSON FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 855","madd2":"","madd3":"","mcity":"Milford","mstate":"ME","mzip":"04461","pcpfaxno":"2079735042","pcpnpi":"1285013771","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8QV7EG2FC46","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":{"indx":["","","",""],"comment":["","","",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":[false,false,false,false,false],"comment":["","","","",""],"score":["","","","",""]}}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03116","B359","E11319","R5383","K219","I10","R0989","N1831","E119","Z794","E782","M25551","L309","E1159","L2084","D509","Z79899","M5450","M47816","Z1231","R051","M25562","R9431","N1832","D508","M7061","G8929","R0609","R079","H2512","Z09","M25561","M25552","R262","J0100","D3131","Z0100","H3554","H04123","A419","H2513","H40023","R0602","R410","H16222","K5730","R509","R1110","M5416","J069","N289","R300","M1712","S8992XA","F1120","R4182","A4151","E1169","R0600","R062","H16223","H35729","N390","M9903","M9901","M542","S83242A","S83282A","X58XXXA","D72829","N3000","R6889","M3501","I340","I517","J029","H2511","K828","R112","R0902","S83232A","A411","N12","M170","Z780","Z0000","Z1211","K5289","K529","Z20822","R0789","R42","E1122"],"date":["2025-09-05","2023-04-07","2023-04-03","2023-04-07","2023-09-19","2025-02-19","2023-05-18","2026-02-09","2023-05-18","2025-12-17","2023-05-18","2023-05-26","2023-06-22","2025-12-17","2023-06-26","2026-01-06","2025-09-30","2026-03-05","2023-09-19","2024-12-23","2025-09-30","2025-08-11","2025-08-29","2024-05-02","2026-02-12","2024-05-22","2025-08-11","2024-05-31","2026-01-15","2025-12-09","2025-09-05","2025-02-26","2025-02-26","2025-02-26","2025-01-10","2024-07-17","2024-07-17","2025-11-06","2024-11-20","2025-09-03","2025-10-13","2024-11-20","2025-10-06","2025-08-29","2026-02-09","2025-08-29","2025-08-31","2025-08-29","2025-05-19","2026-01-13","2025-10-06","2026-01-08","2025-10-17","2025-06-01","2025-05-13","2025-09-01","2025-03-01","2025-05-09","2025-10-06","2025-10-06","2025-10-20","2025-03-27","2025-03-10","2026-03-05","2026-03-05","2026-03-05","2025-10-17","2025-10-17","2025-10-17","2025-03-01","2025-03-01","2025-03-01","2024-08-26","2025-09-02","2025-09-02","2026-01-13","2025-11-25","2025-03-01","2025-03-02","2025-03-02","2025-06-01","2025-08-29","2025-09-03","2025-09-17","2025-12-17","2024-12-03","2023-03-06","2023-03-06","2023-03-06","2023-02-03","2023-02-02","2023-01-17","2023-01-17"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","","","","","","","","","","","",""],"comment":["","","","","","","","","","","","",""],"sub":[]}}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":{"indx":["","","","",""],"comment":["","","","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"score":[0,0,0,0]}},{"a":{"indx":["","","",""],"comment":["","","",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"arr":[],"comment":[]},{"a":{"indx":["","",""],"comment":["","",""],"score":[0,0,0,0]}},{"a":{"indx":["","",""],"comment":["","",""],"score":[0,0,0,0]}},{"a":{"indx":[false],"comment":[""],"score":[""]}},{"a":[{"indx":["",""],"comment":["",""],"sub":[]}]},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":[false,false,false,false,false,false,false,false,false],"comment":["","","","","","","","",""],"score":["","","","","","","","",""]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[["","",""],["","",""],["","",""],["","",""],["","",""],["","",""]]}]},{"t":"Medical History","q":[{"a":{"indx":[],"comment":[],"sub":{"indx":["","","","","","","",""],"comment":[""],"sub":[],"textValue":""}}},{"index":-1,"comment":"","sub":[]},{"a":[{"indx":["","","","","",""],"comment":["","","","","",""],"sub":[]},{"indx":["","","","","",""],"comment":["","","","","",""],"sub":[]},{"indx":["","","","","",""],"comment":["","","","","",""],"sub":[]},{"indx":["","","","","",""],"comment":["","","","","",""],"sub":[]},{"indx":["","","","","",""],"comment":["","","","","",""],"sub":[]}]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","","","","","","","","","","","",""],"comment":["","","","","","","","","","","","",""],"sub":[]}},{"a":{"indx":["","","","","","",""],"comment":["","","","","","",""],"sub":[]}}]},{"t":"Family History","q":[{"index":-1,"comment":"","sub":[]}]},{"t":"Preventive Care","q":[{"a":[["",""],["",""],["",""],["",""],["",""],["",""],["",""],["",""],["",""],["",""],["",""],["",""],["",""],["",""],{"comment":""}]},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"t":"Allergies \/ Medications","q":[{"a":{"index":-1,"commentTxt":"","arr":[]}},{"a":{"comment":"","sub":[["","","Restasis","","","Select","Select",""],["","","FLUCONAZOLE","150 MG","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["depression\/insomnia","","TRAZODONE","50 MG","","Select","Select",""],["muscle spasms","","CYCLOBENZAPRINE","5 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","Onetouch Ultra 2","","","Select","Select",""],["","","Xiidra","","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Lupin","","","Select","Select",""],["GERD","","PANTOPRAZOLE","40 MG","","Select","Select",""],["deprssion\/anxiety","","FLUOXETINE","20 MG","","Select","Select",""],["","","GABAPENTIN","400 MG","","Select","Select",""],["HTN\/CAD\/angina","","AMLODIPINE","5 MG","","Select","Select",""],["","","Cyclosporine Pf 0.05 % Ophth Emuls Mylan","","","Select","Select",""],["HTN\/CKD","","LOSARTAN","100 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["HTN","","CARVEDILOL","6.25 MG","","Select","Select",""],["","","Clobetasol 0.05 % Ointment Encube","","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Encube","","","Select","Select",""],["HTN","","HYDROCHLOROTHIAZIDE","25 MG","","Select","Select",""],["","","Dapagliflozin","10 MG","","Select","Select",""],["hyperlipidemia","","SIMVASTATIN","20 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Ascend Labs","","","Select","Select",""],["","","Ketorolac 0.5 % Ophth Sol Micro Labs","","","Select","Select",""],["DM","","NOVOLIN N","","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["DM","","FARXIGA","","","Select","Select",""],["muscle spasms","","TIZANIDINE","4 MG","","Select","Select",""],["dry eyes","","RESTASIS 0.05%","","","Select","Select",""],["","","TRIAMCINOLONE ACET 0.5%","","","Select","Select",""],["","","CLOBETASOL 0.05%","","","Select","Select",""],["","","PREDNISOLONE ACE","0.01","","Select","Select",""],["","","KETOROLAC","0.005","","Select","Select",""]]}},{"a":{"index":-1,"commentTxt":"","arr":[]}},{"a":{"indx":[],"comment":[],"sub":{"indx":["","","","","","","",""],"comment":[""],"sub":[],"textValue":""}}},{"a":[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}]},{"a":{"indx":[false,false,false,false,false,false],"comment":["","","","","",""],"score":["","","","","",""]}},{"a":{"indx":[false],"comment":[""],"score":[""]}}]},{"t":"Assessment of Diagnoses","q":[{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":[false,false,false,false,false,false,false,false,false],"comment":["","","","","","","","",""],"score":["","","","","","","","",""]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":[false,false,false,false,false],"comment":["","","","",""],"score":["","","","",""]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":[false,false,false,false,false,false,false,false],"comment":["","","","","","","",""],"score":["","","","","","","",""]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":["","","",""],"comment":["","","",""],"sub":[]}},{"a":{"indx":["","","","","",""],"comment":["","","","","",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":[false,false,false,false,false],"comment":["","","","",""],"score":["","","","",""]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}],"phq":[{"indx":["","","",""],"comment":["","","",""],"sub":[]},{"indx":["","","",""],"comment":["","","",""],"sub":[]},{"subGroup":[{"indx":["","","",""],"comment":["","","",""]},{"indx":["","","",""],"comment":["","","",""]},{"indx":["","","",""],"comment":["","","",""]},{"indx":["","","",""],"comment":["","","",""]},{"indx":["","","",""],"comment":["","","",""]},{"indx":["","","",""],"comment":["","","",""]},{"indx":["","","",""],"comment":["","","",""]},{"indx":["","","",""],"comment":["","","",""]},{"indx":["","","",""],"comment":["","","",""]},{"indx":["","","","","",""],"comment":["","","","","","",""]},{"indx":["","","","","",false],"comment":[""]}]}]}},{"a":{"indx":[false,false,false,false,false],"comment":["","","","",""],"score":["","","","",""]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":[false,false,false,false,false],"comment":["","","","",""],"score":["","","","",""]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[{"indx":["",""],"comment":["",""],"sub":[]}]}},{"a":{"indx":[false,false,false,false,false,false],"comment":["","","","","",""],"score":["","","","","",""]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":[false,false,false,false,false],"comment":["","","","",""],"score":["","","","",""]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":[false,false,false,false,false,false,false],"comment":["","","","","","",""],"score":["","","","","","",""]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":[false,false,false,false,false,false,false],"comment":["","","","","","",""],"score":["","","","","","",""]}},{"a":[{"indx":["",""],"comment":["",""],"sub":[]}]},{"a":{"indx":[false,false,false,false,false],"comment":["","","","",""],"score":["","","","",""]}}]},{"t":"Pain","q":[{"a":{"indx":["",""],"comment":["",""],"sub":[[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}]]}}]},{"t":"Vital Signs","q":[{"a":["","","","","","","",false,false,false]},{"a":["","","","",{"txt":""},{"malnutrition":{"indx":["","","","","","",""],"sub":{"indx":[],"comment":[],"sub":[]}}}]},{"a":{"indx":["","","","","","","","","","","",""],"comment":["","","","","","","","","","","",""],"sub":[]}},{"a":{"indx":["","","","","",""],"comment":["","","","","",""],"sub":[]}},{"arr":[],"comment":[]},{"arr":[],"comment":[]},{"a":{"indx":["","","","","","","","",""],"comment":["","","","","","","","",""],"sub":[]}},{"a":{"indx":[false,false,false,false,false],"comment":["","","","",""],"score":["","","","",""]}}]},{"t":"Exam Review","q":[{"a":[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":[""],"comment":[""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}]},{"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":{"indx":[false,false,false],"comment":["","",""],"score":["","",""]}}]},{"t":"Mini-Cog","q":[{"a":{"indx":[false],"comment":[""],"score":[""]}},{"a":{"data":["","1","","","","0"],"indx":[false,false,false,false,false,false,false,false,false,false,false,false,false,false,false,false,false,false],"version":[false,false,false,false,false,false]}},{"a":{"indx":[false,false,false,false,false],"comment":["","","","",""],"score":["","","","",""]}}]},{"t":"Home Safety & Personal Goals","q":[{"a":{"indx":["","","","",""],"comment":["","","","",""],"score":[0,0,0,0]}},{"a":{"indx":[false],"comment":[""],"score":[""]}},{"a":[""]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":{"indx":[false,false,false,false,false],"comment":["","","","",""],"score":["","","","",""]}},{"a":{"indx":[false],"comment":[""],"score":[""]}},{"a":[""]},{"arr":[],"comment":[]},{"a":{"indx":["","","","","","","","","","",""],"comment":["","","","","","","","","","",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"This is a complete face-to-face visit performed in the member\u2019s home. Verbal consent was received by the patient to conduct this HRA visit. Patient identity was verified. Counseling on Preventive Health Maintenance recommendations was provided.  Any conditions NOT identified in the HRA are considered resolved or are unable to be confirmed.  The member has been advised to follow up with their PCP or specialist with any questions involving changes, updates, or alteration of their medications and health care. Member advised to contact member services using the number on the back of insurance card with any plan questions or services needed.","a2":"2026-03-17T09:00","a3":"","a4":"","a5":"true","a6":"","a7":[],"a8":"","a9":"In Person","a10":[],"a11":"","a12":"true","a13":"true","a15":[],"a14":"","a16":"","a18":"true","a20":"true","a21":"true"}]}]}