{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Steven D Flint","gend":0,"currentgend":"","add":"72 WEST GRAY RD","city":"GRAY","state":"ME","zip":"04039","dob":"1955-03-28","age":"","mstatus":"","insh":"10000076729","cliId":"","pno":"2076578188","cno":"","email":"","ename":"","eno":"","pphy":"STOCKWELL, GEORGE W","ppno":"2078930290","pcpadd":"144 STATE ST,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41013776","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY HEALTH CENTER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 1022","madd2":"","madd3":"","mcity":"GRAY","mstate":"ME","mzip":"04039","pcpfaxno":"2078930295","pcpnpi":"1548293772","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7X61T04JD37","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M9903","M5450","M9901","M542","Z0000","M1712","N1831","N281","Z01818","I129","E1122","Z471","E119","Z23","G8918","E1142","E785","D649","Z96652","R7989","M25862","M9902","M546","N1832","M47816","M5137","M10071","M19071","M109","G8929","D509","K909","Z800","Z87891"],"date":["2024-05-31","2024-05-31","2024-05-10","2024-05-10","2024-05-24","2023-10-30","2023-10-10","2024-03-27","2023-10-10","2023-10-10","2023-10-30","2023-11-15","2024-04-18","2023-10-05","2023-10-30","2023-10-30","2023-10-30","2023-10-30","2023-11-15","2023-11-13","2023-10-30","2024-05-31","2024-05-31","2024-03-27","2024-06-26","2024-02-08","2024-05-30","2024-05-30","2024-05-31","2024-06-26","2024-07-05","2024-07-05","2024-07-05","2024-07-05"],"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":[["","","Gavilyte-G","","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","Glimepiride","2 MG","","Select","Select",""],["","","Irbesartan","150 MG","","Select","Select",""],["","","Losartan\/Hydrochlorothiazide","100\/12.5 MG","","Select","Select",""],["","","Embecta Nano 2Nd Gen (Ref 320550)","","","Select","Select",""],["","","Colchicine","0.6 MG","","Select","Select",""],["","","Azithromycin","250 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Metformin","500 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Gabapentin","100 MG","","Select","Select",""],["","","Allopurinol","300 MG","","Select","Select",""],["","","Metoprolol Succ","100 MG","","Select","Select",""],["","","Freestyle","","","Select","Select",""],["","","Unifin Pentips","","","Select","Select",""],["","","Ondansetron","8 MG","","Select","Select",""],["","","Oxycodone Hcl\/Acetaminophen","5\/325 MG","","Select","Select",""],["","","Lantus Solostar","","","Select","Select",""],["","","Amoxicillin","500 MG","","Select","Select",""],["","","Freestyle Lite","","","Select","Select",""],["","","Olmesartan","20 MG","","Select","Select",""],["","","Tramadol","50 MG","","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":""}]}]}