{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Danny C Cote","gend":0,"currentgend":"","add":"104 NEW DAM RD","city":"SANFORD","state":"ME","zip":"04073","dob":"1955-05-01","age":"","mstatus":"","insh":"10000086308","cliId":"","pno":"2074903932","cno":"","email":"declined@01102026.com","ename":"","eno":"","pphy":"LAZOS, SPIROS P","ppno":"2074907998","pcpadd":"SMHC Family Medicine,25A June St Ste 111","pcpcity":"Sanford","pcpstate":"ME","pcpzip":"04073","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY MEDICINE","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"104 NEW DAM RD","madd2":"","madd3":"","mcity":"SANFORD","mstate":"ME","mzip":"04073","pcpfaxno":"2074907999","pcpnpi":"1912968967","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"8TX6AA2CM75","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E782","I10","Z87898","E1165","Z125","R6889","E119","Z0101","H524","H53021","Z0000","E1142","Z794","M9903","M9904","M7918","M5450","K769","Z1211","D122","D123","D124","Z86010","K635","K648"],"date":["2023-05-25","2023-08-14","2023-06-03","2023-12-21","2023-05-25","2023-05-01","2024-04-03","2024-04-03","2024-04-03","2023-06-28","2023-08-21","2024-04-02","2023-08-21","2023-09-19","2023-09-19","2023-09-19","2023-09-01","2024-02-19","2024-04-16","2024-04-16","2024-04-16","2024-04-16","2024-04-16","2024-04-16","2024-04-16"],"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":[["","","True Metrix","","","Select","Select",""],["","","Dapagliflozin","5 MG","","Select","Select",""],["","","Fluzone High-Dose","","","Select","Select",""],["","","Fluad","","","Select","Select",""],["","","Glipizide","10 MG","","Select","Select",""],["","","Comirnaty","","","Select","Select",""],["","","Ezetimibe","10 MG","","Select","Select",""],["","","Peg 3350\/Electrolytes","420 GM","","Select","Select",""],["","","Arexvy","","","Select","Select",""],["","","Fluzone High Dose","","","Select","Select",""],["","","Jardiance","","","Select","Select",""],["","","Lantus Solostar","","","Select","Select",""],["","","Lisinopril\/Hydrochlorothiazide","20\/12.5 MG","","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":""}]}]}