{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donna C Mann","gend":1,"currentgend":"","add":"43 OATWAY LN","city":"Winthrop","state":"ME","zip":"04364","dob":"1956-03-07","age":"","mstatus":"","insh":"10000084570","cliId":"","pno":2073952230,"cno":2074098370,"email":"donnamann@fairpoint.net","ename":"","eno":"","pphy":"SCHIFF SLATER, SCOTT D","ppno":2076260606,"pcpadd":"Hallowell Family Practice,\t9 Union St","pcpcity":"Hallowell","pcpstate":"ME","pcpzip":"04347","pcpcounty":"","pcpid":"","pcpname":"HALLOWELL FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO BOX 34","madd2":"","madd3":"","mcity":"EAST WINTHROP","mstate":"ME","mzip":"04343","pcpfaxno":2076260022,"pcpnpi":1750354957,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"5JT6JN2AC83","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":["I2510","E7800","I10","E1159","Z23","E119","Z794","E785","R413","Z1159","M5126","M47816","M4807","M4805","M25462","M1712","M25562","R32","N3946","N3281","N952","Z0100","R9089","G319","K5900","I700","M5450","M79606","M4800","F32A","Z1231","Z0001","Z7182","Z713","L602","B351","M2041","M2042","E559","Z9181","Z818","R419","R92323","R4189","N3941","M2578","R634","E039","E871","I447","I679","I519","Z79899","I6782","F419","D72829","G478","Z1211","Z1212","G4710","R5383"],"date":["2025-04-11","2025-04-11","2025-07-14","2023-01-19","2025-10-15","2025-10-09","2025-08-22","2025-10-09","2025-07-14","2025-07-08","2023-12-27","2023-12-27","2023-12-27","2023-12-27","2023-01-07","2023-01-07","2023-01-07","2024-09-05","2024-11-19","2024-11-19","2024-11-19","2025-09-26","2022-11-28","2023-03-25","2022-11-28","2022-11-28","2025-08-04","2023-10-17","2023-10-17","2023-10-17","2025-11-03","2025-07-14","2024-09-05","2024-09-05","2024-05-16","2023-11-02","2023-11-02","2023-11-02","2023-08-03","2023-02-13","2023-02-13","2024-04-11","2025-11-03","2025-09-25","2024-08-06","2023-01-21","2025-10-21","2025-10-09","2022-12-20","2025-04-11","2025-03-11","2025-03-11","2025-03-11","2023-03-25","2023-03-14","2022-11-04","2022-08-17","2022-08-19","2022-08-19","2022-08-17","2022-08-17"],"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":[["","","ATENOLOL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","NOVOLOG PENFILL","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","MEMANTINE HCL","","","Select","Select",""],["","","GEMTESA","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""],["","","LEVEMIR FLEXPEN","","","Select","Select",""],["","","DONEPEZIL HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE-BENAZEPRIL","","","Select","Select",""],["","","ESTRADIOL","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","BENAZEPRIL HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","ACCU-CHEK GUIDE TEST STRIP","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","LEVEMIR FLEXTOUCH","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","NOVOLOG FLEXPEN","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","ULTRA-FINE SHORT PEN NEEDLE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"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":""}]}]}