{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sheila M Walker","gend":1,"currentgend":"","add":"94 SUNKEN BRIDGE RD","city":"CORINNA","state":"ME","zip":"04928","dob":"1950-09-22","age":"","mstatus":"","insh":"10000067399","cliId":"","pno":"2073412348","cno":"","email":"","ename":"","eno":"","pphy":"MARTELL, BRIANA J","ppno":"2075644464","pcpadd":"Northern Light Primary Care Dover Foxcroft,891 West Main St Ste 200","pcpcity":"Dover Foxcroft","pcpstate":"ME","pcpzip":"04426","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE DOVER FOXCROFT","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"94 SUNKEN BRIDGE RD","madd2":"","madd3":"","mcity":"CORINNA","mstate":"ME","mzip":"04928","pcpfaxno":"2075644461","pcpnpi":"1356836571","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9HG7A10VT38","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H40013","H2513","H35372","H5213","M151","M7989","Z1211","Z1212","M150","R760","Z0001","Z0000","S4992XA","M25512","R300","S4982XA","M25311","Z96611","T84028A","M75112","R55","A6920","M19012","S82841A","I340","S43004A","M2550","M19011","H02403","H02831","H02834","M2420","Z471","R0789","R0602","R531","I10","E039","E785","S82891D","S99911A","D62","M75121","N3091","S82841D","S82851D","G8918","M25511","Z1231","R768","S43004D","Z01818","Z01811","M25611","M25571","R350","I5189","Z743","S4991XA","R21","S43014D"],"date":["2025-07-07","2025-07-07","2023-06-08","2025-07-07","2023-07-07","2023-07-07","2023-08-06","2023-08-06","2023-09-25","2023-09-25","2023-10-04","2026-01-16","2023-11-14","2026-01-02","2023-12-05","2025-12-05","2025-12-10","2026-03-04","2025-12-08","2026-02-09","2026-02-11","2025-10-08","2026-02-09","2026-02-11","2025-09-13","2025-12-12","2025-08-08","2025-11-17","2026-01-23","2026-01-23","2025-03-21","2026-01-23","2026-03-04","2025-02-12","2025-08-08","2025-07-25","2025-12-08","2025-12-08","2025-12-08","2026-02-25","2026-02-11","2026-03-03","2025-01-23","2025-08-22","2026-03-13","2026-02-18","2025-12-10","2026-02-06","2025-03-10","2025-07-18","2025-12-10","2025-11-10","2025-11-10","2026-02-06","2026-02-12","2025-08-22","2025-09-13","2025-12-08","2025-12-09","2025-07-03","2025-12-05"],"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",""],["","","Amoxicillin\/Clav","500\/125 MG","","Select","Select",""],["","","Propranolol","10 MG","","Select","Select",""],["","","Doxycycline Hyclate","100 MG","","Select","Select",""],["","","Imipramine Hcl","50 MG","","Select","Select",""],["","","Nitrofurantoin Macro\/Mono","100 MG","","Select","Select",""],["","","Gabapentin","400 MG","","Select","Select",""],["","","Prednisone","20 MG","","Select","Select",""],["","","Albuterol Hfa","90 MCG","","Select","Select",""],["","","Omeprazole","20 MG","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Fluoxetine","10 MG","","Select","Select",""],["","","Eliquis","","","Select","Select",""],["","","Atorvastatin","20 MG","","Select","Select",""],["","","Amoxicillin","875 MG","","Select","Select",""],["","","Ibu","","","Select","Select",""],["","","Levothyroxine","75 MCG","","Select","Select",""],["","","Neo\/Polymyx\/Dex 3.5\/10","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}