{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Richard A Myers","gend":0,"currentgend":"","add":"25 BLAINE AVE","city":"AUGUSTA","state":"ME","zip":"04330","dob":"1955-06-13","age":"","mstatus":"","insh":"10000094491","cliId":"","pno":"2076491003","cno":"","email":"sandy.myers14@gmail.com","ename":"","eno":"","pphy":"HANNON, GAVIN","ppno":"","pcpadd":"Northern Light Health Center Unity,80 Main St","pcpcity":"Unity","pcpstate":"ME","pcpzip":"04988","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HEALTH CENTER UNITY","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"25 BLAINE AVE","madd2":"","madd3":"","mcity":"AUGUSTA","mstate":"ME","mzip":"04330","pcpfaxno":"8606454151","pcpnpi":"1992327696","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"9U49UX6EH19","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M62838","M542","M546","M5450","M9900","M9901","M9902","M9903","E039","Z1211","Z800","M25512","R2232","M75112","M19012","M75102","M24012","M7522","Z01818","Z4789","Z4889","M67814","Z96612","Z98890","Z7689","B351","L0291","C8338","C8592","C83398","M79672","M4802","M50121","M4722","Z5112","I7140","R059","N289","M65322","M5011","Z5111","C8332","Z5181","R61","R109","M5412","G5601","E785","E669","M65321","N2889","M151","D649","J40","K429","G5691","M25542","G5603","C8590","M67841","R202","C8510","G8929","R0602","J8410","N281","M65342","M65331","M65341","L03113","Z0389","L03011","D709","R5081","Z9189","Z87442","Z79890","Z79899","D696","C8330","K689","M5031","J439","M25511","C8333","D72829","M792","Z452","R198","Z7185","D84821","T451X5A","G4700","D49511"],"date":["2023-06-07","2025-02-11","2023-06-07","2024-10-25","2023-06-07","2023-06-07","2023-06-07","2023-06-07","2025-11-19","2023-06-28","2023-06-28","2023-07-12","2023-07-12","2023-08-24","2023-08-24","2023-10-26","2023-08-28","2023-08-28","2023-09-14","2024-03-13","2023-12-11","2023-10-26","2024-03-11","2024-02-05","2024-06-27","2024-06-27","2024-07-08","2026-01-21","2025-01-17","2025-06-03","2024-08-01","2025-01-24","2025-01-24","2025-01-24","2025-04-22","2024-12-23","2024-12-06","2024-10-30","2026-01-29","2025-04-10","2025-03-11","2025-06-03","2024-11-12","2024-10-25","2024-10-25","2025-09-02","2025-11-19","2025-11-19","2025-11-19","2025-11-19","2024-10-30","2025-10-01","2025-05-14","2024-11-29","2025-11-04","2025-08-06","2025-09-29","2025-09-02","2024-11-19","2025-11-19","2025-05-08","2025-05-08","2025-05-08","2024-11-30","2025-10-08","2025-10-08","2025-10-02","2025-10-02","2025-10-02","2025-02-26","2025-02-27","2025-03-01","2025-02-28","2025-02-28","2024-11-24","2024-10-28","2024-10-28","2025-02-11","2025-02-26","2025-02-26","2024-10-28","2024-10-17","2024-10-25","2024-10-11","2024-10-29","2024-10-17","2025-02-11","2025-07-01","2024-12-06","2024-11-05","2024-12-16","2024-12-16","2024-11-14","2024-10-29"],"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",""],["","","LEVOFLOXACIN","500 MG","","Select","Select",""],["","","TRAZODONE","50 MG","","Select","Select",""],["","","CYCLOBENZAPRINE","5 MG","","Select","Select",""],["","","ABRYSVO W\/ DILUENT SYRINGE","","","Select","Select",""],["","","ATORVASTATIN","40 MG","","Select","Select",""],["","","FLUZONE HIGH-DOSE","","","Select","Select",""],["","","Peg 3350\/Electrolytes","420 GM","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","LEVOTHYROXINE","100 MCG","","Select","Select",""],["","","SPIKEVAX","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ONDANSETRON","4 MG","","Select","Select",""],["","","PREDNISONE","50 MG","","Select","Select",""],["","","PROCHLORPERAZINE","10 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","ALLOPURINOL","300 MG","","Select","Select",""],["","","Erythromycin 0.5 % Ophth Oint B&L","","","Select","Select",""],["","","GABAPENTIN","100 MG","","Select","Select",""],["","","ACYCLOVIR","400 MG","","Select","Select",""],["","","METHYLPREDNISOLONE","4 MG","","Select","Select",""],["","","PEG","3350\/ELECTROLYTES 420","","Select","Select",""],["","","PREVNAR","","","Select","Select",""],["","","ERYTHROMYCIN","0.005","","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":""}]}]}