{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"John A Ouillette","gend":0,"currentgend":"","add":"133 BURNELL DR","city":"YARMOUTH","state":"ME","zip":"04096","dob":"1948-03-31","age":"","mstatus":"","insh":"10000049743","cliId":"","pno":"2078465770","cno":"","email":"declined@091025.com","ename":"","eno":"","pphy":"NEWCOMBE, JODI A","ppno":"2075351200","pcpadd":"385 ROUTE 1,","pcpcity":"YARMOUTH","pcpstate":"ME","pcpzip":"40966729","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE YARMOUTH","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"133 BURNELL DR","madd2":"","madd3":"","mcity":"YARMOUTH","mstate":"ME","mzip":"04096","pcpfaxno":"2075351249","pcpnpi":"1114339611","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1DV1GH7YN35","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","G243","E119","Z0001","E1165","I10","I4891","I519","I4821","Z7901","I471","H40013","H53453","E782","Z125","R6889","Z23","M5450","D6869","I119","S99922A","S93512A","Z87891","M5136","M47816","R262","Z1211","K5730","K648","Z800","K2970","K219","M4807","M48061","E785","Z0000","R0989","R490","G249","M4726","M1712","M25562","M1711","M25561","M160","M79661","M79662","M47812","M47813","M4802","M5031","M25559","M47817","M170","R29898","G3183","F02A4","G3184","Z96652","R5381","R2689","R2681","M25661","M25662","Z471","Z96653","G20A1","M2578","Z01810","G8929","Z022","R7309","F0390","Z79899","L720","I5189","Z8271","Z01812","G20C","Z1389","S62666B","S62666A","G8918","Z96659","M25569","Z96651","G4730","H532","R7989","R4182","R269","H5213","R413","R29818","Z7189","R296","S3086AA","W57XXXA","R5383","M5416","I77810","M4306","I081","R7303","R0609","U071","R634"],"date":["2026-03-04","2026-02-19","2025-09-19","2025-03-26","2025-10-16","2025-08-13","2025-06-27","2023-09-20","2024-02-14","2025-03-26","2023-09-20","2025-12-08","2024-09-16","2024-11-18","2023-09-22","2023-11-30","2024-09-19","2024-07-23","2023-12-01","2023-12-01","2023-12-07","2023-12-07","2024-11-18","2024-09-11","2025-01-30","2024-03-28","2024-04-17","2024-04-17","2024-04-17","2024-04-17","2024-04-17","2024-04-17","2024-04-25","2024-10-09","2025-06-13","2025-09-19","2024-05-06","2024-05-06","2024-05-06","2024-05-14","2025-07-03","2025-07-11","2025-06-13","2025-07-11","2024-06-07","2024-05-23","2024-05-23","2024-06-03","2024-06-03","2024-06-03","2024-06-03","2024-06-07","2024-06-07","2025-04-09","2024-07-23","2026-02-05","2026-02-05","2026-02-05","2025-07-09","2025-07-09","2026-03-04","2026-03-04","2026-03-04","2026-03-04","2025-10-15","2025-10-15","2025-12-18","2024-10-09","2025-02-24","2024-11-18","2025-07-03","2025-12-08","2025-12-08","2024-11-18","2025-11-24","2025-08-13","2023-03-20","2025-05-21","2025-06-24","2023-03-20","2026-02-18","2026-02-25","2025-06-27","2025-07-03","2025-07-03","2025-06-13","2025-06-13","2025-06-18","2025-07-03","2025-04-10","2025-04-10","2025-03-17","2025-04-10","2025-04-09","2025-04-09","2025-04-09","2025-11-03","2025-11-03","2025-09-19","2024-09-11","2024-08-07","2024-09-12","2023-03-07","2023-03-08","2023-03-06","2023-03-08","2023-03-08"],"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":[["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","XARELTO","","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","ACCU-CHEK GUIDE","","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","CARBIDOPA\/LEVODOPA","25\/100 MG","","Select","Select",""],["","","BUMETANIDE","2 MG","","Select","Select",""],["","","DONEPEZIL","10 MG","","Select","Select",""],["","","ATORVASTATIN","40 MG","","Select","Select",""],["","","METOPROLOL SUCC","25 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ACCU-CHEK SOFTCLIX","","","Select","Select",""],["","","Latanoprost 0.005 % Ophth Sol Somerset","","","Select","Select",""],["","","Latanoprost 0.005 % Ophth Sol Sandoz","","","Select","Select",""],["","","NABUMETONE","500 MG","","Select","Select",""],["","","LISINOPRIL","10 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","PAXLOVID","300\/100 MG","","Select","Select",""],["","","LATANOPROST","0.00005","","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":""}]}]}