{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Steven P Lacko","gend":0,"currentgend":"","add":"175 BARDON HILL RD","city":"ETNA","state":"ME","zip":"04434","dob":"1960-10-30","age":"","mstatus":"","insh":"10000052572","cliId":"","pno":"2074166441","cno":"2074166441","email":"bangobronc9@gmail.com","ename":"","eno":"","pphy":"PANDEY, SANJAY P","ppno":"2079073300","pcpadd":"St Joseph Internal Medicine,900 Broadway","pcpcity":"Bangor","pcpstate":"ME","pcpzip":"04401","pcpcounty":"","pcpid":"","pcpname":"ST JOSEPH INTERNAL MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"175 BARDON HILL RD","madd2":"","madd3":"","mcity":"ETNA","mstate":"ME","mzip":"04434","pcpfaxno":"2079071923","pcpnpi":"1407127475","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8FJ6CR5MQ68","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I2510","I10","E1169","E785","Z98890","E1151","I739","L97511","S98112A","S98212A","Z95828","L97529","Z4800","Z0100","I87303","E11621","L97421","Z0000","I87329","Z1211","Z86010","K621","D122","D123","K635","E1165","I87302","E1142","E6601","Z6838","I87309","I87333","S61001A","W268XXA","I4819","L97413","L97412","L602","L97519","L97829","I252","I87323","I890","E119","Z89422","L97419","R0602","J189","I4891","J168","L97429","D1801","L814","L821","Z7189","D485","I872","L97919","L97929","L97422","I87331","L97822","I5022","I87332","C44619","L728","Z789","R208","I493","L720","L570","L729","Z85828","Z87891","C44519","L309","I87311","G629","S50811A","E113293"],"date":["2025-11-19","2025-11-19","2025-03-13","2025-05-28","2023-11-30","2023-11-30","2024-11-14","2025-10-29","2023-06-05","2023-06-05","2023-11-30","2026-01-23","2026-03-03","2025-10-30","2024-11-22","2026-03-03","2024-04-09","2025-10-01","2025-09-11","2024-03-14","2024-03-14","2024-03-14","2024-03-14","2024-03-14","2024-03-14","2025-12-31","2024-04-09","2024-04-10","2024-04-10","2024-04-10","2026-01-09","2025-10-14","2024-05-26","2024-05-26","2025-11-20","2026-03-03","2026-02-18","2025-06-18","2025-11-05","2026-02-18","2025-11-19","2025-07-01","2025-11-07","2025-08-26","2025-08-26","2025-10-06","2025-02-14","2025-02-14","2025-12-01","2025-02-14","2025-03-18","2026-01-08","2026-01-08","2026-01-08","2026-01-08","2026-01-08","2024-12-27","2025-01-22","2024-12-27","2025-08-26","2025-11-25","2025-05-15","2025-03-31","2025-01-30","2026-01-08","2025-04-08","2025-01-07","2025-01-07","2025-11-19","2025-01-07","2025-04-08","2024-11-07","2024-11-07","2025-10-01","2024-10-07","2024-10-07","2024-11-07","2024-09-25","2024-11-26","2025-10-30"],"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":[["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","Mupirocin 2 % Ointment Teva","","","Select","Select",""],["","","Fluarix Quad 2023-2024","","","Select","Select",""],["","","CARVEDILOL","6.25 MG","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","Clotrim\/Betameth Diprop 1\/0.05 % Cream Tar","","","Select","Select",""],["","","GLIPIZIDE","10 MG","","Select","Select",""],["","","CLOPIDOGREL","75 MG","","Select","Select",""],["","","ATORVASTATIN","10 MG","","Select","Select",""],["","","AMOXICILLIN","875 MG","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","FUROSEMIDE","40 MG","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","DAPAGLIFLOZIN","10 MG","","Select","Select",""],["","","METOPROLOL TART","25 MG","","Select","Select",""],["","","ALBUTEROL","2.5 MG\/0.5","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","FARXIGA","","","Select","Select",""],["","","Metformin 1","","","Select","Select",""],["","","METFORMIN","","","Select","Select",""],["","","CLOTRIM\/BETAMETH DIPROP","1\/0.05 %","","Select","Select",""],["","","FLUARIX QUAD","","","Select","Select",""],["","","MUPIROCIN","0.02","","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":""}]}]}