{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Wayne E Fitch","gend":0,"currentgend":"","add":"68 CASTLE ISLAND RD","city":"BELGRADE","state":"ME","zip":"04917","dob":"1943-01-25","age":"","mstatus":"","insh":"10000046186","cliId":"","pno":"2073133954","cno":"","email":"declined@082523.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":"2076020915","add2":"","add3":"","madd1":"68 CASTLE ISLAND RD","madd2":"","madd3":"","mcity":"BELGRADE","mstate":"ME","mzip":"04917","pcpfaxno":"","pcpnpi":"1760467187","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3HU4VN0AK62","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I4430","I2510","I10","I739","I441","I252","N644","Z955","L282","R748","R7989","Z45018","E221","R42","Z950","B351","Z23","Z0000","R1013","R350","R5383","G4733","R0781","Z0101","M5450","M79662","R058","S2241XA","M79605","J101","T375X5A","M542","I129","N1832","N401","E559","E1165","M47814","R109"],"date":["2023-04-28","2024-03-13","2023-05-05","2024-06-18","2023-05-05","2023-05-19","2023-05-19","2023-05-16","2023-05-31","2023-05-31","2023-06-20","2024-01-26","2023-06-20","2023-07-28","2024-04-26","2024-07-08","2023-11-28","2023-11-28","2023-11-28","2023-11-28","2023-11-28","2023-11-28","2023-12-14","2024-01-08","2024-05-09","2024-02-01","2024-02-18","2024-02-18","2024-02-22","2024-02-18","2024-02-18","2024-06-27","2024-03-13","2024-03-13","2024-03-13","2024-03-15","2024-04-08","2024-04-19","2024-04-19"],"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":[["","","Metoprolol Succ","100 MG","","Select","Select",""],["","","Rosuvastatin","40 MG","","Select","Select",""],["","","Oseltamivir","30 MG","","Select","Select",""],["","","Amlodipine","10 MG","","Select","Select",""],["","","Cilostazol","50 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","Pantoprazole","20 MG","","Select","Select",""],["","","Isosorbide Mononitrate","30 MG","","Select","Select",""],["","","Oseltamivir Phosphate","","","Select","Select",""],["","","Clopidogrel","75 MG","","Select","Select",""],["","","Amlodipine Besylate","","","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":""}]}]}