{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Marian Fletcher","gend":1,"currentgend":"","add":"39 Hillside Ave","city":"Halifax","state":"MA","zip":"02338","dob":"1997-12-18","age":"","mstatus":"","insh":"C0030027000","cliId":"","pno":7742401689,"cno":"","email":"","ename":"","eno":"","pphy":"Remya Tharackal-Ravindran","ppno":5088940400,"pcpadd":"110 Liberty St,Ste 2B","pcpcity":"Brockton","pcpstate":"MA","pcpzip":"02301","pcpcounty":"","pcpid":"","pcpname":"Signature Healthcare Medical Group, Inc.","plan":"Wellsense Health Plan","program":"ACA - Wave 2","lob":"MA","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"39 Hillside Ave","madd2":"","madd3":"","mcity":"Halifax","mstate":"MA","mzip":"02338","pcpfaxno":"","pcpnpi":1639476690,"currentgendcomment":"","pphycomment":"","uniqueid":138956550,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","Z3491","Z3A10","Z3490","Z3A12","N898","Z3492","Z3A17","O99019","R5383","Z3A23","R399","N949","O26892","R109","R55","Z3A27","Z2913","O26899","Z6791","Z3493","Z3A37","R030","O9902","O99343","F32A","O7020","Z3A39","Z370","F411","J029","K120","Z20822","Z3482","Z3689","Z3A22","O9A213","V4950XA","Z3483","Z3A28","Z3A38","Z0184","O80","Z3A00","N610","Z391"],"date":["2025-06-22","2024-09-13","2024-08-28","2025-02-25","2024-09-13","2024-09-03","2024-10-18","2024-10-18","2024-10-29","2025-02-26","2024-11-22","2025-01-28","2024-11-22","2024-12-26","2024-12-26","2024-12-26","2024-12-26","2024-12-26","2024-12-31","2024-12-31","2025-02-21","2025-02-21","2025-02-26","2025-03-16","2025-03-16","2025-03-16","2025-03-16","2025-03-16","2025-03-16","2024-09-30","2024-02-20","2024-02-17","2024-02-20","2024-11-22","2024-08-28","2024-11-22","2024-12-26","2024-12-26","2025-03-11","2024-12-31","2025-03-11","2025-03-16","2025-03-16","2025-03-16","2025-05-19","2025-02-21"],"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":[["","","AMOXICILLIN","","","Select","Select",""],["","","PRENATAL VITAMIN","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","IBUPROFEN","","","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":""}]}]}