{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Robert S Cotiaux","gend":0,"currentgend":"","add":"91 TUFTS RD","city":"NEW GLOUCESTER","state":"ME","zip":"04260","dob":"1955-10-31","age":"","mstatus":"","insh":"10000099287","cliId":"","pno":2072122172,"cno":"","email":"rcotiaux@gmail.com","ename":"","eno":"","pphy":"BARR, DOUGLAS","ppno":2077745816,"pcpadd":"100 FODEN RD WEST,STE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"04106","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"91 TUFTS RD","madd2":"","madd3":"","mcity":"NEW GLOUCESTER","mstate":"ME","mzip":"04260","pcpfaxno":2078741483,"pcpnpi":1134180359,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4N52PH4XD06","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R399","R9720","E7800","D72810","R338","N390","H40013","R197","K769","N281","K5730","R350","R309","R059","H401131","R051","Z23","J189","R6889","Z7189","Z0001","R300","R339","M7541","M6281","M25511","J329","R053","N3000","L03116","M25562","R7303","N139","L820","K7689"],"date":["2025-09-16","2025-07-10","2025-05-19","2025-05-19","2023-08-22","2023-08-22","2023-04-10","2024-11-26","2025-01-16","2025-01-16","2024-11-26","2025-05-27","2025-05-27","2024-01-15","2024-10-28","2022-12-05","2024-11-04","2022-12-05","2023-03-03","2025-01-22","2025-01-22","2025-05-28","2025-05-28","2024-04-24","2024-04-24","2024-04-24","2025-03-31","2025-03-31","2023-07-31","2023-01-26","2023-01-26","2024-01-15","2023-07-30","2024-01-15","2025-01-16"],"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":[["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUTICASONE-SALMETEROL HFA","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","ADVAIR HFA","","","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":""}]}]}