{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michael L Jellison","gend":0,"currentgend":"","add":"13 SUMMER STREET","city":"HAMPDEN","state":"ME","zip":"04444","dob":"1952-03-02","age":"","mstatus":"","insh":"10000091072","cliId":"","pno":"2073071174","cno":"2072492392","email":"mikejellison@yahoo.com","ename":"","eno":"","pphy":"KANUMALLA, RAGHU","ppno":"2079890550","pcpadd":"Northern Light Primary Care Brewer,234 State St","pcpcity":"Brewer","pcpstate":"ME","pcpzip":"04412","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"13 SUMMER STREET","madd2":"","madd3":"","mcity":"HAMPDEN","mstate":"ME","mzip":"04444","pcpfaxno":"2079890551","pcpnpi":"1497313696","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1HC5KJ9KP81","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K2289","I498","I491","R1310","R6884","R9439","R42","I10","E785","Z98890","I6521","Z95828","Z87891","I779","N401","Z0000","Z23","J069","Z7982","M170","I2510","Z79899","L570","Z7902","I6523","R0989"],"date":["2023-04-05","2023-04-07","2023-04-07","2023-04-05","2023-04-25","2023-04-28","2023-04-25","2024-05-16","2024-06-14","2023-05-15","2023-05-15","2023-05-15","2023-12-21","2023-06-09","2023-06-09","2023-10-20","2023-10-20","2023-12-08","2024-03-28","2023-12-20","2023-12-20","2024-03-28","2024-04-24","2024-04-24","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":[["","","Praluent","","","Select","Select",""],["","","Clopidogrel","75 MG","","Select","Select",""],["","","Lisinopril","10 MG","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Ezetimibe","10 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Metoprolol Tart","25 MG","","Select","Select",""],["","","Repatha","","","Select","Select",""],["","","Praluent Pen","","","Select","Select",""],["","","Shingrix","","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Diltiazem","240 MG","","Select","Select",""],["","","Repatha Sureclick","","","Select","Select",""],["","","Metoprolol Succ","25 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":""}]}]}