{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Halina B Obarewicz","gend":1,"currentgend":"","add":"611 MAIN ST APT 302","city":"SOUTH PORTLAND","state":"ME","zip":"04106","dob":"1954-05-29","age":"","mstatus":"","insh":"10000044324","cliId":"","pno":2077736163,"cno":"","email":"","ename":"","eno":"","pphy":"CHAPPELLE, CATHRA M","ppno":2078282402,"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":"611 MAIN ST APT 302","madd2":"","madd3":"","mcity":"SOUTH PORTLAND","mstate":"ME","mzip":"04106","pcpfaxno":2078282425,"pcpnpi":1912957069,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7XQ7V94TR64","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":["Z01818","R109","I2510","R928","I050","I4821","J9811","R918","Z952","Z954","J939","J90","L209","R202","D229","M25552","I080","I083","I3139","M9903","M9902","M9901","Z1231","I052","N611","R002","I4891","Z7901","Z79899","I5020","E785","Z13220","Z13228","L820","R0600","Z48812","Z0101","N610","L570","L720","L821","I051","I4892","J984","R519","N6001","R92333","I340","I499","R4182","H00012","B088","I088","I509","I2584","R931","I495","I442","R6889","I081","R7989","M21611","M67811","I10","I4430","E7800","I219","J439","R200","Z136","L814","M5451","M6249","I484","R42","Z950"],"date":["2025-09-17","2024-10-07","2025-10-02","2024-01-08","2025-09-26","2025-10-20","2025-10-15","2024-10-07","2025-11-04","2025-10-09","2025-10-15","2025-10-15","2023-12-22","2023-12-22","2023-12-22","2025-11-10","2023-09-01","2025-05-06","2025-05-06","2023-09-29","2023-09-29","2023-09-29","2025-02-06","2025-04-29","2025-01-08","2025-10-28","2025-10-28","2023-07-23","2023-07-23","2025-05-06","2025-11-06","2025-11-06","2025-11-06","2024-11-04","2023-07-23","2025-10-03","2025-09-15","2024-12-10","2023-06-23","2024-12-20","2024-12-20","2025-09-25","2025-09-26","2025-09-17","2025-10-28","2024-01-08","2024-01-08","2025-10-03","2025-09-30","2024-08-30","2023-10-02","2023-10-02","2024-08-30","2024-08-29","2024-10-21","2024-10-21","2025-10-01","2025-10-28","2023-05-20","2025-09-25","2025-05-12","2023-04-04","2023-04-04","2025-09-26","2025-09-26","2025-05-06","2025-09-26","2025-09-25","2025-10-28","2025-10-01","2024-12-20","2023-08-21","2023-08-21","2024-08-30","2025-10-28","2025-10-01"],"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":[["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","TORSEMIDE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","VALACYCLOVIR","","","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":""}]}]}