{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy M Basham","gend":1,"currentgend":"","add":"233 UNION RD","city":"WALDOBORO","state":"ME","zip":"04572","dob":"1949-02-25","age":"","mstatus":"","insh":"10000076797","cliId":"","pno":2073804745,"cno":2073804745,"email":"nancy_basham@yahoo.com","ename":"","eno":"","pphy":"CAVANAUGH, CATHERINE E","ppno":2075634250,"pcpadd":"24 MILES CENTER WAY,","pcpcity":"DAMARISCOTTA","pcpstate":"ME","pcpzip":"45434047","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"233 UNION RD","madd2":"","madd3":"","mcity":"WALDOBORO","mstate":"ME","mzip":"04572","pcpfaxno":2075634246,"pcpnpi":1831365311,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4XF8K99QN63","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R002","S42031D","Z1231","M25552","D0461","L570","M4726","I871","G4733","I358","Z0100","E663","G4710","S42031A","Z0000","R0982","Z23","I10","R6889","Z780","M4120","E7800","I7121","I351","L821","D229","Z85828","L820","R072","Z13220","N1830","M48061","M5116","M85852","M5137","M47817","M160","F32A","I77810","I5030","I082","D492","I493","R008","Z131"],"date":["2024-01-10","2025-10-31","2024-11-27","2023-09-06","2024-06-06","2025-09-24","2024-08-06","2023-03-21","2025-10-30","2024-05-13","2024-12-03","2025-10-27","2025-10-27","2025-10-24","2025-03-05","2025-11-12","2024-10-02","2024-10-28","2023-05-02","2024-10-21","2024-04-02","2024-04-26","2024-05-13","2024-05-13","2024-05-30","2025-09-24","2025-09-24","2025-09-24","2023-05-30","2023-02-02","2024-10-02","2024-08-06","2024-08-06","2024-10-21","2023-06-28","2023-06-28","2023-06-28","2024-03-28","2024-05-13","2024-05-13","2023-03-21","2024-05-30","2024-01-09","2024-01-09","2025-03-11"],"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":[["","","FAMOTIDINE","","","Select","Select",""],["","","ATENOLOL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","FLUOROURACIL","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","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":""}]}]}