{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Gerard H Hamann","gend":0,"currentgend":"","add":"536 COBBS BRIDGE RD","city":"NEW GLOUCESTER","state":"ME","zip":"04260","dob":"1954-04-20","age":"","mstatus":"","insh":"10000103838","cliId":"","pno":2076504968,"cno":2076509957,"email":"gerryhamann@gmail.com","ename":"","eno":"","pphy":"CROTHERS, DANIEL S","ppno":2078282402,"pcpadd":"Martins Point Health Care,331 Veranda St","pcpcity":"Portland","pcpstate":"ME","pcpzip":"04103","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"536 COBBS BRIDGE RD","madd2":"","madd3":"","mcity":"NEW GLOUCESTER","mstate":"ME","mzip":"04260","pcpfaxno":2078282433,"pcpnpi":1336601996,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3N46XX2AV79","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":["F959","E119","I2510","M7582","R053","M7581","H903","I10","E7800","R42","Z951","N1832","E1129","R0602","I493","R0609","J90","J9811","E291","M25519","M2550","E1165","M25562","L570","E785","E038","L821","L309","M7580","F32A","K224","K219","R4182","M25511","Z01818","G4762","Z7141","E039","E1122","J329","Z125","K2080","M19011","R0600","R079","E782","R918","J811","Z794","E230","N529","Z4682","R059","N1830","Z1152","J209","Z48812","N189","Z23","Z1211","K2100","I25110","S0990XA","M19012","R002","I200","R9720","R1310","K449","R5383","N1831","R29898","J0190"],"date":["2025-03-07","2025-08-19","2025-03-17","2025-07-08","2024-11-12","2025-07-08","2025-10-20","2025-05-15","2023-09-13","2023-09-13","2024-03-01","2025-05-15","2025-01-24","2024-07-08","2024-06-28","2024-06-28","2024-01-02","2024-01-02","2025-07-16","2025-08-01","2023-08-14","2025-09-25","2023-04-12","2025-05-13","2024-07-24","2024-02-15","2025-10-31","2025-03-07","2025-03-07","2024-05-23","2024-07-24","2024-07-24","2024-07-24","2025-08-08","2023-12-28","2025-09-25","2025-09-25","2025-01-17","2025-06-02","2025-01-17","2025-01-17","2024-07-24","2025-11-10","2024-06-28","2023-12-28","2025-03-17","2023-12-28","2023-12-30","2023-07-13","2023-07-13","2023-09-14","2023-12-29","2024-07-08","2023-12-15","2024-07-08","2023-01-30","2024-01-24","2023-12-15","2023-11-16","2024-01-29","2023-02-10","2023-12-28","2025-10-16","2025-07-08","2024-06-25","2023-12-28","2023-05-03","2024-07-24","2024-07-24","2025-03-17","2025-03-24","2023-03-06","2025-10-31"],"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":[["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","TESTOPEL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","SYNTHROID","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","IRBESARTAN","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","NOVOFINE 32","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","NITROGLYCERIN","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","XYOSTED","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","ULTRA-FINE MICRO PEN NEEDLE","","","Select","Select",""],["","","TESTOSTERONE","","","Select","Select",""],["","","GUANFACINE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","AMIODARONE HCL","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","TESTOSTERONE CYPIONATE","","","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":{"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":""}]}]}