{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Steven M Grant","gend":0,"currentgend":"","add":"88 BOUTELLE RD","city":"BANGOR","state":"ME","zip":"04401","dob":"1953-06-12","age":"","mstatus":"","insh":"10000091716","cliId":"","pno":"2079448030","cno":"","email":"egrant712@gmail.com","ename":"","eno":"","pphy":"COLLINS, AMANDA S","ppno":"2079412373","pcpadd":"EMMC Husson Family Medicine,302 Husson Ave Ste 2","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HUSSON FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"88 BOUTELLE RD","madd2":"","madd3":"","mcity":"BANGOR","mstate":"ME","mzip":"04401","pcpfaxno":"2079418803","pcpnpi":"1881960458","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5HP2FU4VK88","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0001","E1165","E1142","E11621","L97511","L97512","L03031","B351","M79671","M79672","S91101A","Z7982","L570","L814","L821","I10","E782","G40909","R569","D485","B078","Z125","H40013","Z0000","R1013","I491","I493","L97521","E119","I517","Z0101","R109","I444","L97514","M2011","M25774","D225","M66271","R1010","D2272","M19071","L851"],"date":["2023-05-16","2025-09-18","2025-12-15","2023-05-16","2024-06-19","2024-06-19","2024-07-29","2026-01-22","2026-01-22","2026-01-22","2023-07-18","2023-06-29","2025-08-11","2025-08-11","2025-08-11","2025-12-15","2025-12-15","2023-08-17","2025-12-15","2024-01-02","2024-01-02","2024-03-20","2025-03-27","2025-06-11","2026-02-09","2026-02-23","2026-02-23","2025-04-15","2026-02-23","2026-02-10","2025-03-27","2026-02-09","2026-02-09","2024-08-02","2024-07-29","2024-08-02","2025-08-11","2025-07-07","2023-06-23","2025-08-11","2024-08-02","2023-03-10"],"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":[["","","JARDIANCE","","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","CEFADROXIL","500 MG","","Select","Select",""],["","","ACCU-CHEK GUIDE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","12.5 MG","","Select","Select",""],["","","METFORMIN","500 MG","","Select","Select",""],["","","LISINOPRIL","5 MG","","Select","Select",""],["","","ACCU-CHEK GUIDE ME","","","Select","Select",""],["","","PHENYTOIN","100 MG","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","COMIRNATY","","","Select","Select",""],["","","ATORVASTATIN","80 MG","","Select","Select",""],["","","GLIPIZIDE","5 MG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","Ammonium Lac 12 % Cream Taro","","","Select","Select",""],["","","ACCU-CHEK SOFTCLIX","","","Select","Select",""],["","","Comirnaty 2023-2024","","","Select","Select",""],["","","Metformin 1","","","Select","Select",""],["","","AMMONIUM LAC","0.12","","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":""}]}]}