{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dorothy J Whitt","gend":1,"currentgend":"","add":"113 WILDER DAVIS RD","city":"BRADFORD","state":"ME","zip":"04410","dob":"1946-10-27","age":"","mstatus":"","insh":"10000063237","cliId":"","pno":"2079516836","cno":"2079516836","email":"djwhitt46@gmail.com","ename":"","eno":"","pphy":"FAGLES, NINA E","ppno":"2079890550","pcpadd":"84 KELLEY RD,","pcpcity":"ORONO","pcpstate":"ME","pcpzip":"44733416","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"113 WILDER DAVIS RD","madd2":"","madd3":"","mcity":"BRADFORD","mstate":"ME","mzip":"04410","pcpfaxno":"","pcpnpi":"1124069851","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6H33HY4DD14","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z5181","R6889","R918","E042","N184","D649","R7309","R7303","N179","Z0000","K5900","N1831","M8589","Z0101","E559","I779","Z98890","I4710","I129","R001","H26493","N289","N185","D631","I6523","N1832","E785","Z01818","I10","E875","I2699","N189","E1122","Z48812","E119","E039","N186","H26492","Z79899","R0789","R0683","I2720","R079","H26491","I6522"],"date":["2025-08-13","2023-05-11","2023-07-17","2023-07-17","2025-05-05","2025-04-29","2024-01-29","2024-01-29","2025-03-20","2025-09-15","2024-03-12","2024-06-11","2024-03-13","2024-03-20","2024-04-02","2024-03-12","2025-04-02","2024-05-02","2025-07-30","2024-06-11","2024-10-23","2024-06-06","2025-11-18","2025-11-18","2025-04-02","2023-03-20","2025-04-02","2025-03-18","2025-06-09","2025-04-29","2024-07-01","2025-08-04","2025-03-20","2025-06-04","2024-10-14","2024-10-14","2025-03-18","2024-10-17","2025-06-09","2025-04-15","2024-07-15","2024-07-15","2025-04-15","2024-10-10","2023-02-15"],"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":[["","","JANTOVEN","","","Select","Select",""],["","","CARVEDILOL","3.125 MG","","Select","Select",""],["","","LEVOTHYROXINE","25 MCG","","Select","Select",""],["","","ICOSAPENT ETHYL","1 GM","","Select","Select",""],["","","EZETIMIBE","10 MG","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","CALCITRIOL","0.25 MCG","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","ALLOPURINOL","100 MG","","Select","Select",""],["","","DOXAZOSIN","1 MG","","Select","Select",""],["","","CHLORTHALIDONE","25 MG","","Select","Select",""],["","","ROSUVASTATIN","20 MG","","Select","Select",""],["","","FAMOTIDINE","20 MG","","Select","Select",""],["","","LOSARTAN","25 MG","","Select","Select",""],["","","HYDROCODONE\/ACETAMINOPHEN","5\/325 MG","","Select","Select",""],["","","VASCEPA","","","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":""}]}]}