{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rhonda L Pellerin","gend":1,"currentgend":"","add":"5 MAIN ST","city":"WINTERPORT","state":"ME","zip":"04496","dob":"1956-02-28","age":"","mstatus":"","insh":"10000084801","cliId":"","pno":2074461841,"cno":"","email":"","ename":"","eno":"","pphy":"MAMULA, MEGHAN R","ppno":2079891567,"pcpadd":"Brewer Medical Center,735 Wilson St","pcpcity":"Brewer","pcpstate":"ME","pcpzip":"04412","pcpcounty":"","pcpid":"","pcpname":"BREWER MEDICAL CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5 MAIN ST","madd2":"","madd3":"","mcity":"WINTERPORT","mstate":"ME","mzip":"04496","pcpfaxno":2079470435,"pcpnpi":1457456733,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3X05XK5RG93","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M5450","Z1231","Z0101","H5213","R1011","M48061","M5116","M4727","K5792","K2950","K219","R1084","R194","R760","H903","M6281","R32","M1711","M47812","R768","R6889","M5459","H524","H26491","N281","M25561","M5416","J029","N898","R197","Z124","H9191","K319","M9902","Z87820","G501","K5730","M47816","Z7251","M159","Z8261","R42","R262","K3189","M542","I70213","Z1151","Z01419","K5750","K2289","R928","E042","K591","Z113","D649","E875","R5383","Z0000","M9904","M9905","I252","E559","M461","R1013","R112","R94120","K5732","H5212","H5201","S0990XA","E041","W01198A","S0003XA","M26601","H43813","H26493","M8589","K6389","Z1211","G4700","M19041","H9201","R21","H25812","N6001","K648","S199XXA","I739","F0781","R109","K5900","L03116","Z23","M2669","N62","D229","R300"],"date":["2025-07-09","2024-07-17","2025-01-02","2023-02-27","2024-08-19","2024-04-26","2023-01-26","2023-01-26","2024-04-02","2024-04-10","2024-04-10","2024-08-19","2024-08-19","2025-06-09","2024-08-19","2023-06-15","2023-06-15","2025-08-04","2025-05-15","2025-06-09","2023-01-17","2023-03-06","2025-01-02","2023-02-27","2023-12-04","2025-01-11","2024-04-26","2023-10-17","2023-04-18","2024-01-17","2023-04-18","2024-10-23","2024-04-10","2025-04-09","2024-05-28","2024-07-01","2024-01-22","2025-07-09","2025-08-05","2024-04-08","2024-04-08","2024-05-14","2023-12-26","2024-04-10","2024-05-14","2024-11-01","2023-04-18","2023-04-18","2024-02-01","2024-04-10","2024-08-14","2025-10-09","2024-04-09","2025-08-05","2023-10-11","2023-10-11","2025-06-09","2023-10-11","2023-12-14","2023-12-14","2024-02-02","2025-06-09","2023-10-30","2024-04-23","2024-04-23","2024-09-10","2023-11-18","2025-01-02","2025-01-02","2024-05-14","2024-07-12","2024-05-14","2024-05-14","2024-09-24","2023-04-12","2023-04-12","2024-07-17","2024-01-22","2024-01-22","2024-10-22","2024-10-22","2024-09-24","2025-06-09","2023-05-08","2024-08-14","2024-01-22","2024-05-14","2025-08-05","2022-12-16","2023-12-04","2024-04-02","2025-09-09","2022-11-01","2022-11-01","2022-10-04","2022-10-04","2022-09-21"],"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":[["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","HYOSCYAMINE SULFATE","","","Select","Select",""],["","","METOCLOPRAMIDE HCL","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","LACTULOSE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","COMIRNATY 2023-2024","","","Select","Select",""],["","","AREXVY","","","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":""}]}]}