{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy A Grant","gend":1,"currentgend":"","add":"29 SOUTH STREET","city":"GUILFORD","state":"ME","zip":"04443","dob":"1955-12-22","age":"","mstatus":"","insh":"10000104293","cliId":"","pno":"2078762924","cno":"","email":"grantna@myfairpoint.net","ename":"","eno":"","pphy":"MARTELL, BRIANA J","ppno":"2075644464","pcpadd":"Northern Light Primary Care Dover Foxcroft,891 West Main St Ste 200","pcpcity":"Dover Foxcroft","pcpstate":"ME","pcpzip":"04426","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE DOVER FOXCROFT","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 575","madd2":"","madd3":"","mcity":"GUILFORD","mstate":"ME","mzip":"04443","pcpfaxno":"2075644461","pcpnpi":"1356836571","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4JE4UQ8MH80","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0101","H524","H353131","H25813","E119","K224","K449","K2289","G8929","M25512","L918","Z0001","D1724","Z1231","Q828","M79671","E1122","N189","D225","L821","L814","Z7189","L820","L298","R208","R6889","I10","M1712","M25562","E6601","E785","Z1211","E1165","Z0100","H5213","H52223"],"date":["2023-05-15","2024-05-21","2023-05-15","2023-05-15","2024-04-24","2023-06-22","2023-06-22","2023-06-22","2023-07-25","2024-04-16","2024-01-29","2023-10-05","2023-10-03","2023-10-27","2023-10-26","2023-10-26","2023-10-26","2023-10-26","2024-01-29","2024-01-29","2024-01-29","2024-01-29","2024-01-29","2024-01-29","2024-01-29","2023-11-04","2024-04-17","2024-05-07","2024-06-07","2024-04-16","2024-04-16","2024-05-09","2024-05-29","2024-05-21","2024-05-21","2024-05-21"],"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":[["","","Amoxicillin","500 MG","","Select","Select",""],["","","Ketoconazole 2 % Cream Encube","","","Select","Select",""],["","","Ulticare Pen Needle","","","Select","Select",""],["","","Rosuvastatin","10 MG","","Select","Select",""],["","","Onetouch Verio","","","Select","Select",""],["","","Omeprazole","20 MG","","Select","Select",""],["","","Lisinopril","20 MG","","Select","Select",""],["","","Metformin","500 MG","","Select","Select",""],["","","Cyclobenzaprine","10 MG","","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":""}]}]}