{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Roland M Cote","gend":0,"currentgend":"","add":"2070 RIVERSIDE DR","city":"Vassalboro","state":"ME","zip":"04989","dob":"1962-10-17","age":"","mstatus":"","insh":"10000034775","cliId":"","pno":2072134167,"cno":"","email":"Tincan96@yahoo.com","ename":"","eno":"","pphy":"PHELPS, JULIE J","ppno":"","pcpadd":"Waterville Family Practice,31 Front St","pcpcity":"Waterville","pcpstate":"ME","pcpzip":"04901","pcpcounty":"","pcpid":"","pcpname":"WATERVILLE FAMILY PRACTICE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":2072421111,"add2":"","add3":"","madd1":"PO BOX 9","madd2":"","madd3":"","mcity":"Vassalboro","mstate":"ME","mzip":"04989","pcpfaxno":2078731186,"pcpnpi":1679562979,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7ED5YD6UJ80","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K7460","Z933","K5190","S31105A","Z85038","T8131XD","R6889","I4891","R188","I10","G4733","K7469","K435","Z85048","M170","Z1159","E871","K2950","R062","Z8719","K7290","K51919","D72829","I4820","E7800","Z23","K9401","D62","Z0000","Z1331","Z1389","K222","Z139","I4819","G620","T451X5A","M1712","M25562","G8929","M1711","M25461","M25561","Z0101","E8770","J209","I517","K259","K7031","E875","R609","J90","R0602","E785","K7689","R939","R932","R918","R059","J40","Z1289","K5710","J439","Z9049","R109","K8689","K439","K828","R748","N281","R180","N62","G629","I071","C189","D649","C20"],"date":["2025-10-16","2025-10-20","2025-10-20","2025-10-20","2025-10-20","2025-10-20","2023-12-02","2024-11-19","2025-10-24","2025-04-21","2025-11-12","2024-11-08","2024-07-11","2023-10-02","2025-06-30","2023-10-04","2024-12-17","2025-03-03","2025-05-02","2025-03-18","2024-09-30","2024-09-30","2024-07-17","2025-07-03","2023-05-16","2025-05-02","2024-07-08","2024-07-08","2025-05-02","2025-05-02","2025-05-02","2025-03-03","2025-05-02","2023-03-17","2023-03-17","2023-03-17","2025-02-20","2025-02-20","2025-02-20","2025-02-20","2025-02-20","2025-02-20","2025-08-20","2024-11-12","2023-07-06","2023-03-24","2025-06-19","2025-06-19","2024-12-09","2023-02-28","2024-06-05","2023-03-24","2025-02-05","2024-03-28","2024-03-28","2024-03-28","2024-06-05","2022-11-28","2022-11-28","2025-05-29","2024-11-08","2023-05-19","2025-03-18","2023-04-07","2023-08-29","2024-04-30","2023-03-14","2023-03-14","2023-03-14","2025-05-29","2024-04-30","2025-09-08","2023-03-24","2024-07-11","2025-11-04","2022-10-05"],"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":[["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUCELVAX 2025-2026","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","DILTIAZEM 24HR ER (CD)","","","Select","Select",""],["","","FLUCELVAX QUAD 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","BENAZEPRIL HCL","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","FLUCELVAX QUAD 2022-2023","","","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":""}]}]}