{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Constantinos Xoinis","gend":0,"currentgend":"","add":"18 OAK ST","city":"JAY","state":"ME","zip":"04239","dob":"1955-10-22","age":"","mstatus":"","insh":"10000121229","cliId":"","pno":2078974505,"cno":"","email":"","ename":"","eno":"","pphy":"COTA, LINDA W","ppno":2078976601,"pcpadd":"21 MAIN ST,","pcpcity":"LIVERMORE FALLS","pcpstate":"ME","pcpzip":"42541219","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"18 OAK STREET","madd2":"","madd3":"","mcity":"JAY","mstate":"ME","mzip":"04239","pcpfaxno":2078974339,"pcpnpi":1780181818,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2NN4CM8AM78","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z510","Z5111","C321","Z452","C760","N281","R1310","Z931","J690","Z4889","Z79630","E8342","R300","E860","E1165","N289","L598","K117"],"date":["2025-02-07","2025-02-24","2025-02-25","2025-01-10","2025-01-10","2025-01-23","2025-02-14","2025-02-14","2025-02-27","2025-01-20","2025-02-10","2025-02-10","2025-01-16","2025-02-26","2025-01-16","2025-01-23","2025-02-07","2025-02-07"],"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":[["","","CAREONE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","SCOPOLAMINE","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","CHLORPROMAZINE HCL","","","Select","Select",""],["","","ULTRA-FINE MICRO PEN NEEDLE","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","TRUE METRIX GLUCOSE TEST STRIP","","","Select","Select",""],["","","LIDOCAINE HCL VISCOUS","","","Select","Select",""],["","","TRUE METRIX BLOOD GLUCOSE MTR","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","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":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}