{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Earle F Chapman","gend":0,"currentgend":"","add":"110 Old Winthrop Rd","city":"Augusta","state":"ME","zip":"04330","dob":"1940-03-29","age":"","mstatus":"","insh":"10000010676","cliId":"","pno":"","cno":2076260204,"email":"echap43021@aol.com","ename":"","eno":"","pphy":"Gene Cheng","ppno":2076224400,"pcpadd":"6 Middle St,","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"Gene Cheng Md","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"110 Old Winthrop Rd","madd2":"","madd3":"","mcity":"Augusta","mstate":"ME","mzip":"04330","pcpfaxno":2076229894,"pcpnpi":1679534770,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4N68CQ1QV61","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z08","I129","E785","M1712","C189","R059","I700","M19012","Z96611","Z87891","Z1389","F331","Z1211","K5730","K648","Z980","G20","G3184","M67432","N184","K759","G20A1","I2510","Z0001","I10","R0602","M9903","M47816","M5450","M48061","M5136","M25462","M25562","Z0100","H35371","Z85038","Z85048","R918","E669","N1830","R809","E8889","M5440","S46012A","W19XXXA","Z0000","N189","K432","F419","R7309","N400","N281","K4090","M25512","Z23","R7401","M533","Z20822","J0110","J020","N401","S4992XA","W08XXXA","R9431","R251","Z9181","Z79899","K5090","E041","K219","M25539","R221"],"date":["2025-08-12","2025-08-07","2025-05-07","2025-04-24","2024-01-29","2024-09-24","2024-09-24","2025-08-19","2025-08-19","2025-08-19","2023-06-13","2025-04-01","2025-05-14","2025-05-14","2025-05-14","2025-05-14","2023-08-16","2025-04-08","2023-09-14","2025-07-28","2024-08-02","2025-06-02","2024-01-29","2024-09-23","2025-07-11","2022-10-31","2024-06-26","2024-06-26","2023-10-26","2023-04-27","2023-04-27","2023-12-15","2024-08-23","2025-04-15","2025-04-15","2024-08-06","2024-08-06","2024-08-06","2023-10-26","2023-03-07","2023-03-07","2023-03-07","2023-04-27","2025-06-02","2025-06-02","2025-04-02","2022-10-12","2023-01-12","2023-07-19","2024-09-24","2025-04-04","2023-07-26","2023-07-26","2025-04-11","2022-10-12","2024-12-31","2023-07-05","2023-11-02","2023-11-02","2023-11-02","2025-04-03","2024-12-24","2024-12-24","2022-10-31","2024-09-30","2024-09-30","2024-09-30","2023-10-23","2025-06-03","2023-12-14","2023-07-31","2025-06-03"],"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":[["","","OLANZAPINE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","MYRBETRIQ","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","GAVILYTE-N","","","Select","Select",""],["","","NEBIVOLOL HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","SIMVASTATIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","ADACEL TDAP","","","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":""}]}]}