{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Roger P Cote","gend":0,"currentgend":"","add":"105 SANDBAR RD","city":"WINDHAM","state":"ME","zip":"04062","dob":"1954-07-13","age":"","mstatus":"","insh":"10000069614","cliId":"","pno":2072728361,"cno":"","email":"Rcote501@gmail.com","ename":"","eno":"","pphy":"EMERSON, FRED E","ppno":2078923233,"pcpadd":"301C US ROUTE 1,","pcpcity":"SCARBOROUGH","pcpstate":"ME","pcpzip":"40749701","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE INTERNAL MEDICINE AND PED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"105 SANDBAR RD","madd2":"","madd3":"","mcity":"WINDHAM","mstate":"ME","mzip":"04062","pcpfaxno":2078930752,"pcpnpi":1487722278,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1P68M14PH41","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M170","H5310","M1711","M25561","Z0000","Z0001","G4733","J329","Z0101","H35373","E6601","Z6841","E782","Z713","G2581","L280","F330","F419","G4700","E611","L989","R7303","M1712","R002","Z79899","R300","R110","M19042","Z125","M7702","R6889","G4750","F5101","G4730","E8881","H5213","R059","K625","M25562","R21","R051","B9689","K5730","Z1211","I10","K219","Z860100","M25522","F332","R7989","H43391","R1030","R350","R1031","R1032","F5104","H26493"],"date":["2025-11-06","2025-11-06","2022-12-01","2022-12-15","2024-07-19","2025-04-28","2025-10-27","2025-07-02","2023-10-25","2024-10-29","2025-04-28","2025-04-28","2025-07-28","2023-10-26","2025-03-27","2025-07-07","2024-07-19","2023-10-20","2025-03-27","2023-05-30","2023-03-24","2023-03-24","2022-12-22","2023-07-12","2025-10-22","2023-07-10","2023-07-14","2023-02-19","2023-10-09","2023-07-07","2023-07-17","2024-06-04","2023-01-30","2025-03-27","2023-03-10","2022-11-28","2023-07-11","2025-02-07","2022-12-15","2025-07-02","2025-07-02","2025-07-02","2025-02-07","2025-02-07","2025-02-07","2025-02-07","2025-02-07","2022-10-28","2022-10-18","2022-03-16","2022-03-10","2021-11-23","2021-11-24","2021-11-23","2021-11-23","2021-12-14","2022-02-17"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","PRAMIPEXOLE DIHYDROCHLORIDE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","FLUCELVAX TRIVALENT 2024-2025","","","Select","Select",""],["","","METHADONE HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ZALEPLON","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","OXCARBAZEPINE","","","Select","Select",""],["","","DAYVIGO","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","NEUPRO","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","NORTRIPTYLINE HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID (12Y UP) VAC(EUA)","","","Select","Select",""],["","","HORIZANT","","","Select","Select",""],["","","RAMELTEON","","","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":{"indx":[["","","",""],[],[""],[""],[],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[],[""],[""],[""],[""],[""],[""]],"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":""}]}]}