{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Constantin E Liakas","gend":0,"currentgend":"","add":"16 AMHERST ST","city":"AUGUSTA","state":"ME","zip":"04330","dob":"1953-04-28","age":"","mstatus":"","insh":"10000048190","cliId":"","pno":2074580525,"cno":"","email":"Tliakas@gmail.com","ename":"","eno":"","pphy":"CHELEUITTE, RAMON E","ppno":"","pcpadd":"12 Spruce St Ste 7,","pcpcity":"Augusta","pcpstate":"ME","pcpzip":"04330","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"16 AMHERST ST","madd2":"","madd3":"","mcity":"AUGUSTA","mstate":"ME","mzip":"04330","pcpfaxno":2076219766,"pcpnpi":1114059672,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8UM0A33WF32","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K5190","N529","F419","Z0000","Z0100","Z87891","M1812","K529","R6889","C44601","H6123","R1310","Z974","Z09","Z125","I4891","F1020","E559","M25552","M542","M79669","H16143","K6389","K648","K219","K589","M79645","R238","H04123","E782","Z01818","R079","D649","Z79899"],"date":["2025-10-28","2024-12-23","2024-12-23","2024-07-29","2025-03-10","2025-03-26","2023-07-11","2025-02-24","2023-06-21","2023-01-10","2025-06-16","2024-12-11","2024-12-11","2024-03-14","2023-03-29","2025-10-09","2024-12-23","2024-07-02","2025-05-19","2025-05-19","2025-05-19","2023-03-02","2025-06-12","2025-06-12","2025-10-09","2024-10-23","2023-05-26","2023-01-10","2024-12-18","2024-02-20","2024-02-20","2025-10-09","2022-10-18","2022-10-18"],"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",""],["","","RENFLEXIS","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","RESTASIS","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","PREVNAR 20","","","Select","Select",""],["","","FLUOROMETHOLONE","","","Select","Select",""],["","","XIIDRA","","","Select","Select",""],["","","FLUAD QUAD 2022-2023","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","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":""}]}]}