{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Patricia E Chandler","gend":1,"currentgend":"","add":"86 SPRING ST APT 203","city":"South Portland","state":"ME","zip":"04106","dob":"1939-05-07","age":"","mstatus":"","insh":"10000066340","cliId":"","pno":2077438033,"cno":"","email":"pchandler94@gmail.com","ename":"","eno":"","pphy":"KINGMAN, MEAGAN R","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":"86 SPRING ST APT 203","madd2":"","madd3":"","mcity":"South Portland","mstate":"ME","mzip":"04106","pcpfaxno":2078282433,"pcpnpi":1477992097,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6RT6KJ3CA43","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":["D0439","H2512","H2511","H5213","Z961","H52203","H04123","H40023","H43811","M059","N950","M25511","R293","R531","M75120","M79651","S76011D","Z79899","L820","D225","L821","D1801","L728","M1611","M19011","M75121","R748","R053","B351","M79674","L602","M79675","H2513","H5340","L570","L578","M2011","M2041","D485","L02611","L600","L03031","H5711","S4361XA","S46011A","S46211A","W19XXXA","I10","E039","Z4689","N819","Z87891","S4361XD","M1990","M069","M7060","N189","E785","M25551","H524","H538","H02052","E871","D649","K219","R059","Z20822","Z03818","Z681","J310","M79604","R030","Z85828","N8110","S43409A","H02053","F418"],"date":["2025-01-17","2023-03-28","2023-02-28","2023-08-28","2023-10-31","2023-08-28","2025-04-15","2025-05-01","2024-06-18","2025-10-03","2025-10-07","2024-06-04","2024-06-04","2024-06-04","2024-05-16","2024-11-18","2024-11-18","2025-10-03","2025-10-21","2025-10-21","2025-10-21","2025-10-21","2025-10-21","2024-05-09","2024-08-06","2024-08-06","2023-10-24","2023-10-24","2025-09-16","2025-09-16","2025-09-16","2025-09-16","2023-01-25","2025-05-01","2025-05-06","2024-08-07","2024-09-17","2024-09-17","2024-08-07","2024-09-04","2024-09-04","2024-09-04","2023-12-20","2024-05-03","2024-04-24","2024-04-24","2024-04-24","2024-04-23","2025-05-28","2025-07-22","2025-07-22","2025-09-17","2024-04-26","2023-02-28","2023-08-04","2025-05-28","2025-05-28","2025-05-28","2024-09-24","2023-07-24","2023-07-24","2023-07-24","2024-06-18","2024-06-18","2024-01-09","2023-08-29","2023-08-29","2023-08-29","2023-08-29","2023-10-09","2023-04-11","2023-04-11","2025-05-06","2023-09-21","2024-03-17","2024-10-16","2023-03-28"],"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":[["","","XELJANZ XR","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","HYDROXYCHLOROQUINE SULFATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","BOOSTRIX TDAP","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":""}]}]}