{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sandra Y Michaud","gend":1,"currentgend":"","add":"30 ACORN LN","city":"LEBANON","state":"ME","zip":"04027","dob":"1955-10-15","age":"","mstatus":"","insh":"10000099361","cliId":"","pno":"2074083041","cno":"","email":"Sandram1055@yahoo.com","ename":"","eno":"","pphy":"BAXTER, CLARKE W","ppno":"2072445513","pcpadd":"4760 RED BANK RD STE 104,","pcpcity":"CINCINNATI","pcpstate":"OH","pcpzip":"45227154","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE ELLSWORTH","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"39 S MAIN ST 224","madd2":"","madd3":"","mcity":"ROCHESTER","mstate":"NH","mzip":"03867","pcpfaxno":"2072445515","pcpnpi":"1487711909","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6MJ1T05KY05","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E871","Z1339","F419","F32A","F17210","I10","H6982","Z1231","Z23","Z0000","Z780","Z122","Z87891","Z13820","H9122","H6123","H8302","J4489","J90","R0602","Z48813","R0689","S92354A","S82842A","J9601","R0902","S82852D","M79672","W19XXXA","Z4789","S82852B","E1152","Z4781","L2989","Z89519","S2241XA","E1169","L299","Z1211","J189","S00431A","S8252XK","S90912D","L981","S8292XA","J441","S82842D","D649","R100","D508","R059","R262","J449","Z736","L0390","M25572","S91002A","B3789","R197","M7989","L309","T8131XA","Z89522","F1010","B1920","S41111A","M8580","Z87310","Z9189","S88112A","J14","Z89512","J9621","R58","L814","Z79899","J811","T148XXA","S82892D","D509","L03116","J9811","S81802A","S92351D","Z96642","M7062","M1990"],"date":["2026-02-20","2023-10-19","2026-03-05","2023-08-02","2024-12-20","2025-06-06","2023-07-25","2023-11-02","2025-11-06","2024-10-16","2023-11-02","2023-11-29","2023-11-29","2023-11-02","2024-03-12","2024-03-12","2024-03-12","2025-09-12","2024-11-21","2026-01-06","2024-08-23","2024-05-23","2024-06-17","2024-06-14","2024-06-19","2024-08-20","2024-09-05","2024-06-13","2024-12-20","2024-07-24","2024-07-02","2024-11-21","2025-06-16","2026-01-02","2025-03-23","2026-01-06","2024-11-21","2026-03-05","2024-11-19","2026-01-06","2026-02-03","2024-11-14","2024-11-05","2026-01-28","2024-06-27","2024-12-17","2024-11-14","2025-03-03","2026-01-17","2026-03-05","2026-03-05","2024-12-11","2024-12-11","2024-12-11","2025-08-21","2024-10-24","2024-11-08","2026-01-16","2026-01-18","2025-08-21","2025-05-20","2024-12-20","2025-01-02","2024-12-04","2024-12-04","2025-03-13","2024-09-12","2024-09-12","2024-09-12","2025-06-06","2024-08-20","2025-05-27","2024-08-22","2024-12-20","2025-09-30","2025-09-30","2026-01-17","2025-01-16","2024-06-20","2025-12-04","2025-08-21","2024-11-21","2025-06-06","2024-09-05","2024-12-20","2023-02-17","2023-02-14"],"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":[["","","PRAVASTATIN","10 MG","","Select","Select",""],["","","OXYCODONE HCL","5 MG","","Select","Select",""],["","","Triamcinolone Acet 0.5 % Ointment Perrigo","","","Select","Select",""],["","","Mupirocin 2 % Ointment Padagis","","","Select","Select",""],["","","Mometasone 0.1 % Ointment Padagis","","","Select","Select",""],["","","FLUTICASONE PROP","50 MCG","","Select","Select",""],["","","CEFPODOXIME","200 MG","","Select","Select",""],["","","FLUOXETINE","40 MG","","Select","Select",""],["","","PROPRANOLOL","10 MG","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","100 MG","","Select","Select",""],["","","PANTOPRAZOLE","40 MG","","Select","Select",""],["","","BREO ELLIPTA","","","Select","Select",""],["","","HYDROXYZINE HCL","25 MG","","Select","Select",""],["","","IBUPROFEN","600 MG","","Select","Select",""],["","","ALBUTEROL\/IPRATROPIUM","3\/0.5 MG\/3","","Select","Select",""],["","","AMLODIPINE","10 MG","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","CEPHALEXIN","500 MG","","Select","Select",""],["","","TRAZODONE","100 MG","","Select","Select",""],["","","CLONIDINE","0.3 MG","","Select","Select",""],["","","Tacrolimus 0.1 % Ointment Padagis","","","Select","Select",""],["","","Dulera","","","Select","Select",""],["","","Clobetasol 0.05 % Cream Encube","","","Select","Select",""],["","","Mometasone 0.1 % Cream Padagis","","","Select","Select",""],["","","CIPROFLOXACIN","500 MG","","Select","Select",""],["","","NYSTOP","","","Select","Select",""],["","","CEFUROXIME","500 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Encube","","","Select","Select",""],["","","METHYLPREDNISOLONE","4 MG","","Select","Select",""],["","","SULFAMETHOXAZOLE\/TRIMETHOPRIM","800\/160 MG","","Select","Select",""],["","","Permethrin 5 % Cream Encube","","","Select","Select",""],["","","IBU","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","Nystatin 100","","","Select","Select",""],["","","MOMETASONE","0.001","","Select","Select",""],["","","TACROLIMUS","0.001","","Select","Select",""],["","","CLOBETASOL","0.0005","","Select","Select",""],["","","PERMETHRIN","0.05","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.005","","Select","Select",""],["","","MUPIROCIN","0.02","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}