{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Dana J Jacques","gend":0,"currentgend":"","add":"130 COMINS LN","city":"EDDINGTON","state":"ME","zip":"04428","dob":"1951-06-17","age":"","mstatus":"","insh":"10000101506","cliId":"","pno":"4013185078","cno":"","email":"","ename":"","eno":"","pphy":"LUNDQUIST, BRYAN J","ppno":"","pcpadd":"PO BOX 7291,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42437291","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT FAMILY MEDICINE AND RESIDENCY","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"130 COMINS LN","madd2":"","madd3":"","mcity":"EDDINGTON","mstate":"ME","mzip":"04428","pcpfaxno":"2077778800","pcpnpi":"1558302273","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1EY1CP7RT01","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E113291","Z0101","H5203","R6889","L821","L570","L989","L918","D485","D225","L814","Z7189","C44219","Z0000","E1122","I10","E782","I2510","M65342","G5601"],"date":["2023-05-16","2024-05-21","2024-05-21","2023-05-25","2024-03-27","2024-03-27","2023-06-20","2023-08-09","2023-08-09","2024-03-27","2024-03-27","2024-03-27","2023-11-02","2023-10-03","2024-04-04","2024-04-04","2023-10-03","2023-10-03","2024-03-19","2024-06-24"],"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":[["","","Lisinopril","5 MG","","Select","Select",""],["","","Amitriptyline","25 MG","","Select","Select",""],["","","Tramadol","50 MG","","Select","Select",""],["","","Colchicine","0.6 MG","","Select","Select",""],["","","Atorvastatin","40 MG","","Select","Select",""],["","","Allopurinol","300 MG","","Select","Select",""],["","","Freestyle Precision Neo","","","Select","Select",""],["","","Freestyle","","","Select","Select",""],["","","Cephalexin","500 MG","","Select","Select",""],["","","Glipizide","5 MG","","Select","Select",""],["","","Shingrix","","","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":""}]}]}