{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Philipp M Laplante","gend":0,"currentgend":"","add":"56 HARPSWELL NECK","city":"Harpswell","state":"ME","zip":"04079","dob":"1950-06-08","age":"","mstatus":"","insh":"10000063870","cliId":"","pno":2078379633,"cno":"","email":"michaelinharpswell@yahoo.com","ename":"","eno":"","pphy":"SHEPHERD, AMBER","ppno":2077984400,"pcpadd":"Sheepscot Valley Health Center,114 Bath Rd","pcpcity":"Brunswick","pcpstate":"ME","pcpzip":"04011","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"56 HARPSWELL NECK","madd2":"","madd3":"","mcity":"Harpswell","mstate":"ME","mzip":"04079","pcpfaxno":2078282433,"pcpnpi":1477941425,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"2KV6A92AN45","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z125","E1140","M2042","L852","R262","Z136","Z0000","R070","G5602","I10","K219","E669","Z8739","S42232D","S42352A","S42232A","W009XXA","M19012","M25512","S4292XD","S4292XA","R509","Z4789","R062","G629","Z131","R059","S42202A","M25412","Z23","Z13220"],"date":["2024-10-15","2024-10-09","2024-10-09","2024-10-09","2024-10-09","2024-10-15","2023-10-24","2023-12-01","2023-11-24","2023-11-24","2023-11-24","2023-11-24","2024-10-15","2023-02-13","2022-12-16","2022-12-19","2022-12-19","2022-12-16","2023-04-06","2023-04-06","2022-12-16","2023-12-01","2023-12-04","2024-02-23","2025-01-21","2023-10-06","2023-04-27","2022-12-17","2022-12-16","2023-10-13","2022-09-27"],"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":[["","","OXYCODONE HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","TYRVAYA","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","ALBUTEROL SULFATE 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":{"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":""}]}]}