{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert E Fennell","gend":0,"currentgend":"","add":"699 HUSSEY RD","city":"ALBION","state":"ME","zip":"04910","dob":"1951-04-25","age":"","mstatus":"","insh":"10000056489","cliId":"","pno":"2073561421","cno":"","email":"robertfennell4570@gmail.com","ename":"","eno":"","pphy":"FITZPATRICK, JENNIFER","ppno":"","pcpadd":"Sebasticook Valley Health,80 Main St","pcpcity":"Unity","pcpstate":"ME","pcpzip":"49883732","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HEALTH CENTER UNITY","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"699 HUSSEY RD","madd2":"","madd3":"","mcity":"ALBION","mstate":"ME","mzip":"04910","pcpfaxno":"","pcpnpi":"1285485912","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2P58K94QK52","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H1031","J22","R059","R0981","M722","M1712","Z0001","I10","Z79899","Z87891","M79602","M2550","Z0000","Z5189","I159","H35363","H527","H2513","H40013","Z8546","Z9079","C61","Z122","H25811","H25812","M25569"],"date":["2023-04-03","2023-04-03","2024-03-12","2023-04-22","2023-05-19","2024-06-11","2023-07-18","2023-11-29","2023-07-18","2024-04-22","2023-07-18","2023-07-18","2023-07-18","2023-10-02","2023-07-18","2024-03-19","2024-03-19","2024-03-19","2024-03-19","2024-04-01","2024-04-01","2024-02-27","2024-04-22","2024-05-30","2024-05-30","2024-06-11"],"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":[["","","Losartan","100 MG","","Select","Select",""],["","","Ibuprofen","600 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Cyclobenzaprine","10 MG","","Select","Select",""],["","","Paxlovid","300\/100 MG","","Select","Select",""],["","","Epinephrine","0.3 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Atorvastatin","10 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Meloxicam","15 MG","","Select","Select",""],["","","Ketoconazole 2 % Cream Fougera","","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","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":""}]}]}