{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Ralph K Thurlow","gend":0,"currentgend":"","add":"29 ESCUTARSIS RD","city":"LOWELL","state":"ME","zip":"04493","dob":"1959-01-24","age":"","mstatus":"","insh":"10000111038","cliId":"","pno":"2076316206","cno":"","email":"declined@10082025.com","ename":"","eno":"","pphy":"JOHNSTON, PAULINE K","ppno":"","pcpadd":"43 WHITING HILL RD STE 300,","pcpcity":"BREWER","pcpstate":"ME","pcpzip":"44121006","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT PRIMARY CARE BREWER","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"29 ESCUTARSIS RD","madd2":"","madd3":"","mcity":"LOWELL","mstate":"ME","mzip":"04493","pcpfaxno":"2079735042","pcpnpi":"1598705360","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7TH4QY0TR78","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J984","R911","C7802","C679","R8289","N3289","Z5112","Z452","Z8551","C9010","C96Z","C9000","C7951","C7800","C672","H0510","J439","Z0000","C9030","D649","H05221","H5711","H532","H579","Z5111","R918","M898X8","H43813","Z87891","Z800","K5730","Z126","H539","H2513","H04123","H25813","Z79899","D7589","C3490","C678","J90","J929","Z0101","H5213","H524","H52203","N179","N289","H05011","D61818","H0520","H05229"],"date":["2025-10-29","2025-05-13","2024-08-27","2026-02-23","2024-03-07","2025-09-11","2026-02-02","2024-04-23","2025-03-07","2025-11-17","2025-11-12","2026-03-02","2025-09-30","2025-09-30","2025-09-30","2025-12-09","2026-02-23","2024-12-20","2025-11-12","2025-11-08","2025-12-06","2025-12-06","2025-12-06","2025-12-06","2025-09-04","2025-12-05","2025-10-28","2025-12-22","2025-08-27","2025-08-27","2025-05-13","2025-09-11","2025-12-05","2024-07-23","2024-07-23","2025-10-29","2025-10-29","2025-11-04","2024-09-09","2025-09-17","2026-02-23","2026-02-23","2025-08-19","2025-08-19","2025-08-19","2025-08-19","2025-12-04","2025-09-11","2025-12-06","2025-12-06","2025-12-06","2025-12-06"],"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",""],["","","BALVERSA","","","Select","Select",""],["","","PROCHLORPERAZINE","10 MG","","Select","Select",""],["","","LENALIDOMIDE","25 MG","","Select","Select",""],["","","ALLOPURINOL","300 MG","","Select","Select",""],["","","DEXAMETHASONE","4 MG","","Select","Select",""],["","","ONDANSETRON","8 MG","","Select","Select",""],["","","VALACYCLOVIR","500 MG","","Select","Select",""],["","","BACLOFEN","5 MG","","Select","Select",""],["","","Eliquis","","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","GABAPENTIN","300 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","Erythromycin 0.5 % Ophth Oint B&L","","","Select","Select",""],["","","POTASSIUM CL","20 MEQ","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","Triamcinolone Acet 0.1 % Lotion Quagen","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","TRIAMCINOLONE ACET","0.001","","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":""}]}]}