{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan M Lohnes","gend":1,"currentgend":"","add":"3 ALAN STREET","city":"Topsham","state":"ME","zip":"04086","dob":"1944-04-26","age":"","mstatus":"","insh":"10000042162","cliId":"","pno":2078373471,"cno":2078373471,"email":"bslohnes@comcast.net","ename":"","eno":"","pphy":"DECK, MARCUS M","ppno":2077984400,"pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"3 ALAN STREET","madd2":"","madd3":"","mcity":"Topsham","mstate":"ME","mzip":"04086","pcpfaxno":2077984018,"pcpnpi":1891717872,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3H88XK7WD29","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":["K5641","N8110","H35373","D3131","H43811","H02413","R002","M810","H04123","R0602","Z1231","K5900","L821","I781","K219","K30","H5213","R079","H16223","R0789","H35372","H35371","K635","L820","R1013","I471","E785","K5730","R059","K120","R5383","K146","G35","H52203","H903","H6990","Z0000","J45909","R6889","M8000XA","K5649","R61","F439","E041","M47812","R109","K1379","K148","Z23","I700","R220","H524","G9389","J324","R202","R3915","N8111","N398","R3989"],"date":["2024-05-10","2024-04-03","2025-06-02","2025-06-02","2025-06-02","2023-11-03","2024-04-02","2024-04-01","2024-11-25","2023-02-18","2025-06-11","2024-08-15","2025-10-02","2025-10-02","2024-05-24","2023-02-06","2024-11-25","2024-05-04","2024-12-02","2024-05-03","2024-04-25","2024-04-25","2024-08-15","2024-08-01","2023-02-06","2023-03-08","2025-01-27","2024-08-15","2023-08-27","2023-08-27","2023-08-27","2025-07-23","2025-07-23","2024-11-25","2024-12-18","2024-02-07","2024-02-05","2024-11-07","2023-06-24","2024-03-14","2024-05-24","2025-07-17","2025-05-14","2025-03-20","2025-03-20","2024-05-10","2025-03-21","2025-03-21","2024-01-11","2023-08-27","2025-03-20","2022-12-12","2025-05-30","2025-05-30","2025-05-30","2022-09-01","2022-09-06","2022-09-01","2022-09-01"],"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":[["","","ESOMEPRAZOLE MAGNESIUM","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","ARNUITY ELLIPTA","","","Select","Select",""],["","","FLOVENT HFA","","","Select","Select",""],["","","ELETRIPTAN HBR","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","MIEBO","","","Select","Select",""],["","","PAXLOVID (EUA)","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FLUOROMETHOLONE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","FLUTICASONE PROPIONATE HFA","","","Select","Select",""],["","","TENIVAC","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","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":""}]}]}