{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Edward C Schulz","gend":0,"currentgend":"","add":"38 RANGE E RD","city":"LIMERICK","state":"ME","zip":"04048","dob":"1953-09-19","age":"","mstatus":"","insh":"10000048063","cliId":"","pno":"","cno":"2072982127","email":"declined@020426.com","ename":"","eno":"","pphy":"HORNE, JENNIFER L","ppno":"2079737979","pcpadd":"43 WHITING HILL RD,SUITE 300","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121005","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE GORHAM","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 204","madd2":"","madd3":"","mcity":"LIMERICK","mstate":"ME","mzip":"04048","pcpfaxno":"2079479579","pcpnpi":"1174903694","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7PM8NV1EA10","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F321","F411","Z658","F605","R1012","M549","L723","L259","Z09","K5909","Z86010","I10","L720","M4124","M25519","M47816","K861","K581","F909","F609","Z6826","K5730","K648","K2270","K449","K2970","F4310","K22719","M9903","M9902","H9192","Z599","K219","E785","R454","R002","R4589","M9905","M4185","M9904","Z6825","F418"],"date":["2024-03-25","2023-04-17","2023-11-28","2024-07-03","2023-05-22","2023-06-26","2023-06-26","2023-06-26","2023-08-01","2023-07-27","2023-09-25","2024-07-01","2023-08-01","2023-05-22","2023-05-22","2024-05-20","2023-08-21","2023-08-21","2024-04-30","2024-04-30","2024-04-30","2023-10-03","2023-10-03","2024-07-01","2024-07-01","2023-10-03","2023-10-03","2024-01-17","2024-05-20","2024-05-20","2023-10-26","2023-11-06","2024-01-17","2024-07-01","2024-05-01","2024-02-26","2024-03-25","2024-05-20","2024-04-22","2024-05-20","2024-05-09","2024-07-01"],"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":[["","","Doxycycline Monohydrate","100 MG","","Select","Select",""],["","","Clonazepam","","","Select","Select",""],["","","Dextroamphet\/Amphet","5 MG","","Select","Select",""],["","","Nitrofurantoin Macro\/Mono","100 MG","","Select","Select",""],["","","Dextroamphetamine-Amphetamine","","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Ascend Labs","","","Select","Select",""],["","","Omeprazole","40 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Celecoxib","200 MG","","Select","Select",""],["","","Lisinopril","40 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Saptalis","","","Select","Select",""],["","","Atorvastatin","20 MG","","Select","Select",""],["","","Atenolol","100 MG","","Select","Select",""],["","","Tizanidine","4 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":""}]}]}