{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Lorraine M Johnson","gend":1,"currentgend":"","add":"1700 BROADWAY APT 167","city":"South Portland","state":"ME","zip":"04106","dob":"1930-04-06","age":"","mstatus":"","insh":"10000037398","cliId":"","pno":2077749974,"cno":"","email":"declined@021420.com","ename":"","eno":"","pphy":"NANNICELLI, ANGELEA","ppno":2077998596,"pcpadd":"Martins Point Health Care,153 US Rte 1","pcpcity":"Scarborough","pcpstate":"ME","pcpzip":"04074","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1700 BROADWAY APT 167","madd2":"","madd3":"","mcity":"South Portland","mstate":"ME","mzip":"04106","pcpfaxno":2077778800,"pcpnpi":1366253098,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4A24C42KA81","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E119","R2681","R2689","M6281","U071","N3090","H401133","Z0100","Z7982","R059","M65341","M65351","D485","R42","Z8701","R519","L821","M25571","L570","L578","D229","H353131","I2510","Z23","H903","C44311","R1084","R053","D492","I77810","J8410","R4182","J479","I872","F419","E042","Z0000","Z043","I517","R7989","W19XXXA","R051","R531","I700","S0990XA","L290","L2489","K641","R109","K529","K8020","R0989","E538","K5730","M79671","G4700","H5713","R0600","E781","I639","J209","R062","E7800","I10","N1832","H401122","H401111","C44319","G459","G9389","G319","J329","I77819","I69998","H04123","D472","N2581","I25119","I8312","D0439","D2339","Z85828","I130","M5116","E1122","C44722","D0472","H40052","E1142"],"date":["2025-05-28","2023-09-08","2023-09-08","2023-09-08","2023-02-14","2024-12-05","2025-05-29","2024-10-23","2024-12-05","2023-11-14","2025-05-01","2025-05-01","2025-05-06","2025-05-27","2023-02-14","2025-05-27","2025-05-06","2024-09-17","2025-09-09","2024-10-28","2024-10-28","2024-11-18","2025-07-23","2024-05-24","2024-03-19","2024-09-23","2024-09-16","2024-09-04","2024-09-23","2024-07-01","2024-07-01","2025-05-27","2023-02-03","2025-09-09","2025-05-28","2025-09-14","2025-05-28","2025-11-10","2025-11-10","2025-11-10","2025-11-10","2025-09-19","2025-11-10","2025-11-10","2025-11-10","2024-06-19","2024-06-19","2024-06-19","2024-02-13","2024-09-16","2024-02-13","2023-11-14","2025-05-23","2024-09-16","2023-04-07","2024-11-12","2024-11-12","2023-02-03","2025-05-23","2025-05-27","2024-06-22","2024-06-22","2025-05-23","2025-05-23","2023-03-17","2023-04-14","2023-04-14","2024-04-12","2025-05-27","2023-02-14","2023-02-14","2023-02-14","2023-02-14","2023-02-14","2023-04-14","2023-03-17","2023-03-17","2023-02-09","2025-05-06","2025-05-06","2025-05-06","2024-04-12","2024-12-03","2024-12-03","2024-12-03","2022-10-18","2022-10-18","2022-08-25","2022-08-30"],"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":[["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","DORZOLAMIDE-TIMOLOL","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","HYDROCORTISONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","PROCTO-MED HC","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","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":""}]}]}