{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michael L Chapman","gend":0,"currentgend":"","add":"237 CLARKS MILL RD","city":"HOLLIS CENTER","state":"ME","zip":"04042","dob":"1955-04-04","age":"","mstatus":"","insh":"10000101244","cliId":"","pno":"2072472855","cno":"","email":"hawkowl55@gmail.com","ename":"","eno":"","pphy":"BAUM, KRISTEN M","ppno":"2072823349","pcpadd":"SMHC Internal Medicine,46 Barra Rd Stes 201","pcpcity":"Biddeford","pcpstate":"ME","pcpzip":"04005","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"237 CLARKS MILL RD","madd2":"","madd3":"","mcity":"HOLLIS CENTER","mstate":"ME","mzip":"04042","pcpfaxno":"","pcpnpi":"1538797576","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6TM5KG7KN50","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H16232","H35372","H18513","I340","I77810","E782","G894","M47817","M461","M7061","M5135","M47816","M5134","M47814","M549","E039","M47818","M48061","M5127","M5136","M419","Z0101","H40013","I2609","R42","K219","I088","Z95818","I2699","I959","H27112","T8529XA","Z125","D120","D122","D123","D500","D649","H27122","R7989","D7589","D125"],"date":["2024-01-09","2024-01-09","2023-04-13","2023-04-20","2023-12-06","2023-09-25","2023-12-07","2024-01-30","2023-04-25","2023-11-07","2023-09-13","2023-09-13","2023-09-13","2023-09-13","2023-09-25","2023-09-25","2024-06-12","2023-10-13","2023-10-13","2023-10-13","2023-10-13","2023-10-31","2023-10-31","2023-12-07","2023-12-07","2023-12-07","2023-12-06","2023-12-06","2023-12-21","2023-12-05","2024-03-18","2023-12-29","2024-03-26","2024-04-02","2024-04-02","2024-04-02","2024-04-02","2024-04-02","2024-03-18","2023-12-21","2023-12-21","2024-04-02"],"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":[["","","Lovastatin","40 MG","","Select","Select",""],["","","Xarelto","","","Select","Select",""],["","","Tramadol","50 MG","","Select","Select",""],["","","Cyclobenzaprine","5 MG","","Select","Select",""],["","","Trazodone","50 MG","","Select","Select",""],["","","Pantoprazole","40 MG","","Select","Select",""],["","","Peg 3350\/Electrolytes","420 GM","","Select","Select",""],["","","Duloxetine","60 MG","","Select","Select",""],["","","Levothyroxine","112 MCG","","Select","Select",""],["","","Metronidazole","500 MG","","Select","Select",""],["","","Ciprofloxacin","500 MG","","Select","Select",""],["","","Prednisolone Ace 1 % Ophth Susp Sandoz","","","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":""}]}]}