{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Wayne Jacobs","gend":0,"currentgend":"","add":"77 ARCTIC STATION ROAD","city":"ORRINGTON","state":"ME","zip":"04474","dob":"1958-10-24","age":"","mstatus":"","insh":"10000085262","cliId":"","pno":"2079079000","cno":"","email":"waj.pe@pm.me","ename":"","eno":"","pphy":"MYERS, MOLLIE R","ppno":"2079737979","pcpadd":"Northern Light Primary Care Hampden,7 Main Rd N","pcpcity":"Hampden","pcpstate":"ME","pcpzip":"04444","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE HAMPDEN","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"77 ARCTIC STATION ROAD","madd2":"","madd3":"","mcity":"ORRINGTON","mstate":"ME","mzip":"04474","pcpfaxno":"2079737579","pcpnpi":"1154944312","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3UE0VH4WC23","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0101","H40033","Z0000","E785","I10","H409","E6601","R7303","R9720","N400","L820","Z789","L538","D225","L821","L814","L728"],"date":["2023-06-05","2023-12-29","2023-08-22","2023-09-20","2023-09-20","2023-08-22","2023-08-22","2023-09-20","2023-09-29","2023-09-29","2024-05-16","2024-05-16","2024-05-16","2024-05-16","2024-05-16","2024-05-16","2024-05-16"],"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":[["","","Latanoprost 0.005 % Ophth Sol B&L","","","Select","Select",""],["","","Modafinil","200 MG","","Select","Select",""],["","","Penicillin Vk","500 MG","","Select","Select",""],["","","Doxycycline Monohydrate","100 MG","","Select","Select",""],["","","Zepbound","","","Select","Select",""],["","","Carvedilol","25 MG","","Select","Select",""],["","","Amlodipine","5 MG","","Select","Select",""],["","","Rosuvastatin","20 MG","","Select","Select",""],["","","Trazodone","100 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Armodafinil","","","Select","Select",""],["","","Spikevax","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Perphenazine","","","Select","Select",""],["","","Losartan","100 MG","","Select","Select",""],["","","Latanoprost 0.005 % Ophth Sol Greenstone","","","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":""}]}]}