{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michael F Locke","gend":0,"currentgend":"","add":"900 TODDY POND RD","city":"SURRY","state":"ME","zip":"04684","dob":"1953-07-13","age":"","mstatus":"","insh":"10000066924","cliId":"","pno":"2074603077","cno":"","email":"michaellocke04684@gmail.com","ename":"","eno":"","pphy":"PAINTER, DAVID M","ppno":"","pcpadd":"Northern Light Primary Care Blue Hill,57 Water St","pcpcity":"Blue Hill","pcpstate":"ME","pcpzip":"04614","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BLUE HILL","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 246","madd2":"","madd3":"","mcity":"SURRY","mstate":"ME","mzip":"04684","pcpfaxno":"2072888600","pcpnpi":"1033180476","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8F84QD7PU01","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H2511","H2512","M19072","E538","H903","L600","I10","E119","R600","S4991XA","S42211A","S42201A","S42301D","R609","S42209A","T07XXXA","V2999XA","S42201D","M810","H35362","Z9884","Z7182","Z0001","Z0000","M7500","R0789","R0609","R000","R059","G5621","Z98890","J45909","J683","R079","M7501","G5601"],"date":["2023-04-04","2023-04-11","2023-07-18","2023-09-21","2024-06-13","2023-07-18","2023-06-27","2023-07-18","2023-07-18","2023-08-06","2023-08-06","2023-11-30","2023-08-09","2023-08-14","2023-08-06","2023-08-06","2023-08-06","2023-11-30","2023-09-21","2023-11-14","2023-12-12","2023-12-12","2023-12-29","2024-01-04","2024-03-07","2024-02-26","2024-02-26","2024-02-26","2024-02-26","2024-03-28","2024-03-28","2024-03-13","2024-02-28","2024-02-26","2024-04-10","2024-05-29"],"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":[["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Pacific","","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Mresvia","","","Select","Select",""],["","","Ketorolac 0.4 % Ophth Sol Pacific","","","Select","Select",""],["","","Moxifloxacin Pf 0.5 % Ophth Sol Upsher-Smi","","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","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":""}]}]}