{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Susan P Bass","gend":1,"currentgend":"","add":"111 MAQUOIT DR","city":"FREEPORT","state":"ME","zip":"04032","dob":"1954-04-11","age":"","mstatus":"","insh":"10000108816","cliId":"","pno":"2074010835","cno":"","email":"soutybass@yahoo.com","ename":"","eno":"","pphy":"BADILLO, JEFFREY","ppno":"2075351200","pcpadd":"Northern Light Mercy Primary Care Yarmouth,385 Rte 1","pcpcity":"Yarmouth","pcpstate":"ME","pcpzip":"04096","pcpcounty":"","pcpid":"","pcpname":"NORTHERN LIGHT MERCY PRIMARY CARE YARMOUTH","plan":"Martin's Point","program":"Medicare","lob":"GA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"111 MAQUOIT DR","madd2":"","madd3":"","mcity":"FREEPORT","mstate":"ME","mzip":"04032","pcpfaxno":"2075351249","pcpnpi":"1619538964","currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6PD3FN4TE94","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F321","F411","R600","M7741","M2021","M2011","Z1231","G4733","F324","S0501XA","M19042","M79644","M79645","S99921A","M7660","S52514A","S8000XA","W010XXA","S52591A","T148XXA","Z4789","G4759","S52591D","H5203","G3184","R6889","H02052","G4737","Z8659","G4730","L988","Z87891","E538","D225","G4750","Z122","G4731","R918","R413","Z79899","G309","K5900","H9193","R200","R109","G300","F3175","M79671","M9903","M5450","M9902","M9901","J9601","J189","Z0101","M542","R0602","F4310","J391","R140","J3089","I77810","M5451","M549","M25552","M25512","H539","H43812","M1812","M65312","I499","J440","M7742","J329","J390","R221","R042","M25511","R1032","K5730","Z0001","J449","H6690","R519","R0981","R9431","J069","F0390","R928","I2510","J439","N6489","R059","E663","Z6826","F0280","J36","R0682","R052","J984","R079","R0600","J300","M629","F02A4","R0982","J3489","R5383","J168","R058","I700","S29011A","M47812","Z006","Z6827","J029","D899","K219","J387","K589","M6208","M4807","J441","H31002","H25811","G3189"],"date":["2025-04-18","2026-02-05","2024-07-17","2023-11-28","2023-11-28","2023-11-28","2025-10-20","2026-01-21","2026-02-05","2025-05-21","2023-10-02","2023-10-04","2023-10-04","2023-10-04","2023-10-11","2023-10-11","2023-10-11","2023-10-11","2023-10-19","2023-11-15","2023-12-07","2025-10-07","2023-11-15","2024-09-12","2026-01-07","2023-12-13","2024-01-08","2025-07-23","2024-01-23","2024-01-23","2024-01-19","2026-02-19","2024-01-29","2024-01-19","2024-03-04","2025-11-03","2026-01-31","2026-03-05","2024-04-26","2026-02-10","2026-01-14","2026-02-17","2024-06-14","2024-06-18","2025-10-16","2025-04-18","2025-06-26","2024-07-05","2025-12-16","2025-12-16","2025-12-16","2025-12-16","2026-01-21","2026-02-05","2025-09-17","2025-09-03","2026-01-16","2026-02-25","2025-10-28","2025-10-16","2025-10-28","2026-01-16","2025-03-05","2025-03-05","2025-09-22","2025-01-14","2025-02-15","2025-02-17","2025-09-09","2025-09-09","2025-09-04","2026-01-23","2024-07-17","2025-12-17","2025-09-03","2025-09-03","2025-09-03","2025-12-17","2024-05-13","2024-05-13","2025-07-29","2026-02-19","2025-06-04","2025-12-25","2025-12-25","2025-12-25","2025-03-08","2025-11-05","2024-10-18","2025-11-03","2025-11-03","2024-10-18","2026-01-05","2024-11-18","2024-11-18","2026-01-14","2025-09-03","2026-02-13","2025-03-18","2026-01-05","2026-02-13","2026-01-05","2025-12-31","2025-04-01","2024-12-12","2026-02-18","2026-02-18","2025-03-27","2026-01-05","2025-03-08","2025-03-08","2026-02-13","2025-01-09","2025-01-13","2024-08-14","2025-09-02","2025-09-22","2026-02-10","2026-02-10","2024-11-18","2025-10-16","2025-01-09","2026-01-23","2024-10-09","2024-10-09","2025-05-06"],"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":[["","","Mupirocin 2 % Ointment Teva","","","Select","Select",""],["","","Oxycodone Hcl","5 MG","","Select","Select",""],["","","YUVAFEM","","","Select","Select",""],["","","PREDNISONE","10 MG","","Select","Select",""],["","","PROPRANOLOL","10 MG","","Select","Select",""],["","","Spikevax 2023-2024","","","Select","Select",""],["","","FLUAD","","","Select","Select",""],["","","ESTRADIOL","10 MCG","","Select","Select",""],["","","CLONAZEPAM","0.5 MG","","Select","Select",""],["","","Diclofenac Sod 1 % Gel Cipla","","","Select","Select",""],["","","BUPROPION HCL","150 MG","","Select","Select",""],["","","DONEPEZIL","5 MG","","Select","Select",""],["","","Ofloxacin 0.3 % Ophth Sol Apotex","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","SERTRALINE","50 MG","","Select","Select",""],["","","FLUZONE HIGH DOSE","","","Select","Select",""],["","","SPIKEVAX","","","Select","Select",""],["","","ALBUTEROL HFA","90 MCG","","Select","Select",""],["","","ARIPIPRAZOLE","10 MG","","Select","Select",""],["","","Moxifloxacin 0.5 % Ophth Sol Aurobindo","","","Select","Select",""],["","","CYPROHEPTADINE","4 MG","","Select","Select",""],["","","Prevnar 20","","","Select","Select",""],["","","Mupirocin 2 % Ointment Encube","","","Select","Select",""],["","","Erythromycin 0.5 % Ophth Oint B&L","","","Select","Select",""],["","","Anoro Ellipta","","","Select","Select",""],["","","Fluad Quad 2023-2024","","","Select","Select",""],["","","Trelegy Ellipta","","","Select","Select",""],["","","FAMOTIDINE","40 MG","","Select","Select",""],["","","Ipratropium 0.03 % Nas Spray B&L","","","Select","Select",""],["","","TRAMADOL","50 MG","","Select","Select",""],["","","Ipratropium 0.06 % Nas Spray B&L","","","Select","Select",""],["","","AMOXICILLIN\/CLAV","875\/125 MG","","Select","Select",""],["","","AZITHROMYCIN","250 MG","","Select","Select",""],["","","Nystatin 100","","","Select","Select",""],["","","MOXIFLOXACIN","0.005","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","FLUAD QUAD","","","Select","Select",""],["","","DICLOFENAC SOD","0.01","","Select","Select",""],["","","OFLOXACIN","0.003","","Select","Select",""],["","","PREVNAR","","","Select","Select",""],["","","ERYTHROMYCIN","0.005","","Select","Select",""],["","","IPRATROPIUM","0.0003","","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":""}]}]}