{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Caroline F Crowell","gend":1,"currentgend":"","add":"110 EVERGREEN DR","city":"Waterville","state":"ME","zip":"04901","dob":"1938-12-04","age":"","mstatus":"","insh":"10000042722","cliId":"","pno":"","cno":"2073146161","email":"caroling@roadrunner.com","ename":"","eno":"","pphy":"DOUGLAS, JAMES W","ppno":"","pcpadd":"10 WASHINGTON ST,","pcpcity":"WATERVILLE","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE CLINTON","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"110 EVERGREEN DR","madd2":"","madd3":"","mcity":"Waterville","mstate":"ME","mzip":"04901","pcpfaxno":"","pcpnpi":"1760467187","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3FT0W86UD35","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z1283","L570","D1801","L821","Z0000","E039","E782","K219","Z86007","Z872","R300","D044","H52229","H35371","H04123","H43813","Z961","M810","L909","L905","M65331","Z23","Z1231","M62830","H02054","M9900","M9901","M9902","M9908","M542","M9903","M9905","Z0001","I081","I2720"],"date":["2024-04-08","2024-04-08","2023-09-13","2023-04-03","2024-05-24","2023-12-12","2023-12-12","2023-05-25","2023-05-31","2023-05-31","2023-06-15","2023-09-13","2023-09-27","2024-03-06","2024-03-06","2023-09-27","2023-09-27","2023-12-12","2023-12-07","2023-12-07","2023-12-12","2024-01-04","2024-01-10","2024-02-01","2024-03-06","2024-04-18","2024-04-18","2024-03-14","2024-03-14","2024-04-18","2024-04-18","2024-04-18","2024-06-04","2024-06-13","2024-06-13"],"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":[["","","Mupirocin 2 % Ointment Padagis","","","Select","Select",""],["","","Nitrofurantoin Macro\/Mono","100 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Pravastatin","40 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":""}]}]}