{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Peggy J Pellerin","gend":1,"currentgend":"","add":"16 PELLERIN PL","city":"FAIRFIELD","state":"ME","zip":"04937","dob":"1949-12-14","age":"","mstatus":"","insh":"10000037904","cliId":"","pno":2074539816,"cno":"","email":"peggypellerin@gmail.com","ename":"","eno":"","pphy":"CHAMBERLAIN, DEAN E","ppno":2074379388,"pcpadd":"Lovejoy Health Center,7 School St Ste 1","pcpcity":"Albion","pcpstate":"ME","pcpzip":"04910","pcpcounty":"","pcpid":"","pcpname":"LOVEJOY HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"16 PELLERIN PL","madd2":"","madd3":"","mcity":"FAIRFIELD","mstate":"ME","mzip":"04937","pcpfaxno":2076261849,"pcpnpi":1922360411,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3JC3UY9YE73","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":["Z1211","K635","B349","E119","M9903","M5442","M9904","M5451","H401131","M9901","M531","M9902","L905","E1129","C44329","H40053","L989","Z0001","H5203","Z23","Z20822","K644","K5730","I10","M25541","E785","J0190","M810","C44529","M65312","Z1231","R928","N6489","Z0101","N6311","D485","M25561"],"date":["2024-07-11","2024-07-11","2024-01-10","2025-09-16","2025-11-17","2023-10-25","2023-10-25","2023-10-25","2025-07-28","2025-11-17","2025-11-17","2025-11-17","2023-03-21","2023-01-02","2023-01-10","2023-06-15","2023-01-10","2024-07-30","2024-12-18","2024-10-30","2023-06-22","2024-07-11","2024-07-11","2024-10-21","2024-10-21","2024-10-21","2023-06-22","2025-10-30","2023-03-21","2023-10-17","2024-08-12","2022-12-19","2022-12-19","2025-07-28","2022-12-19","2023-01-10","2022-09-14"],"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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","LATANOPROST","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","ONETOUCH VERIO FLEX METER","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","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":{"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":""}]}]}