{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lois H Wood","gend":1,"currentgend":"","add":"758 BROADWAY","city":"BANGOR","state":"ME","zip":"04401","dob":"1931-07-04","age":"","mstatus":"","insh":"10000102190","cliId":"","pno":"6032529329","cno":"","email":"declined@email.com","ename":"","eno":"","pphy":"KEITH, ALLISON C","ppno":"","pcpadd":"43 WHITING HILL RD,SUITE 300","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121005","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT HUSSON FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"758 BROADWAY","madd2":"","madd3":"","mcity":"BANGOR","mstate":"ME","mzip":"04401","pcpfaxno":"2079735042","pcpnpi":"1285013771","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5X15Q05PX70","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R262","M25511","M25512","M25612","M19011","M19012","S81801A","I2510","Z952","Z7901","X58XXXA","Z4800","G4721","F330","S81801D","M7552","M7551","M25552","D649","Z0000","H40013","I10","I480","G4733","E785","R5383","R0600","R600","J3489","K047","K0889","Z87891","I517","T1490XA","W050XXA","I2721","T148XXA","S01512A","T8130XA","S01512D","R0609","R21","M1612","I5030","R0602","R42","R059","R109","R1110","I4891","M79674","L851","B351","M79675","R112","K8020","J189","R2689","S90414A","L309","R7989","R051","M169","F331","E559","Z131","K810","Z1152","Z043","S0990XA","I130","N1831","G8929","F17290","N1830","Z0001","I071","I2720","H43813","H16223"],"date":["2025-03-27","2025-03-27","2025-03-27","2025-03-27","2024-01-16","2024-08-05","2023-08-16","2023-08-09","2024-03-27","2025-02-26","2023-08-16","2023-08-16","2025-05-29","2025-08-28","2023-10-13","2023-10-11","2023-10-11","2025-08-20","2026-01-08","2023-10-20","2023-10-30","2025-11-03","2023-10-20","2025-10-31","2023-10-20","2025-02-26","2025-06-05","2025-10-20","2023-12-27","2024-01-08","2023-12-28","2025-10-20","2024-01-18","2024-03-08","2024-03-08","2024-04-01","2025-10-20","2024-04-18","2024-04-30","2024-04-30","2024-04-19","2024-06-21","2025-08-20","2025-07-09","2025-05-14","2025-05-14","2025-11-25","2025-12-04","2025-12-04","2025-12-04","2025-03-19","2025-03-19","2025-03-19","2025-03-19","2025-12-05","2025-12-04","2025-11-25","2025-08-28","2025-02-26","2025-02-26","2025-05-14","2026-01-07","2025-06-09","2026-01-28","2025-02-26","2025-02-26","2026-01-01","2025-11-25","2025-10-20","2025-10-20","2025-11-03","2026-01-08","2025-08-20","2025-08-20","2024-09-12","2024-11-08","2025-07-09","2025-07-09","2023-03-01","2023-03-01"],"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":[["","","NYSTOP","","","Select","Select",""],["","","FLUCONAZOLE","150 MG","","Select","Select",""],["","","Ondansetron","4 MG","","Select","Select",""],["","","HYDROXYZINE HCL","25 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Macleods","","","Select","Select",""],["","","OXYBUTYNIN","10 MG","","Select","Select",""],["","","ATORVASTATIN","80 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","Mirtazapine","7.5 MG","","Select","Select",""],["","","AMLODIPINE","2.5 MG","","Select","Select",""],["","","Diclofenac Sod 1 % Gel Cipla","","","Select","Select",""],["","","DULOXETINE","60 MG","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","DOXEPIN","6 MG","","Select","Select",""],["","","IBUPROFEN","400 MG","","Select","Select",""],["","","KLAYESTA","","","Select","Select",""],["","","Fluocinolone 0.01 % Top Oil Taro","","","Select","Select",""],["","","Methocarbamol","500 MG","","Select","Select",""],["","","FUROSEMIDE","20 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Perrigo","","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","Chlorhexidine 0.12 % Oral Rinse Xttrium","","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","DRIZALMA SPRINKLE","","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Cream Ascend Labs","","","Select","Select",""],["","","Fluzone High-Dose Quad 2023-24","","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","DOXEPIN HCL","","","Select","Select",""],["","","MOMETASONE FUROATE","","","Select","Select",""],["","","Mometasone 0.1 % Ointment G&W","","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.001","","Select","Select",""],["","","FLUOCINOLONE","0.0001","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD","","","Select","Select",""],["","","DICLOFENAC SOD","0.01","","Select","Select",""],["","","CHLORHEXIDINE","0.0012","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","MOMETASONE","0.001","","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":""}]}]}