{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Donna Santorelli","gend":1,"currentgend":"","add":"473 OLD ROCHESTER RD","city":"SOMERSWORTH","state":"NH","zip":"03878","dob":"1963-03-07","age":"","mstatus":"","insh":61000047700,"cliId":"","pno":"6033436044","cno":"","email":"","ename":"","eno":"","pphy":"Maureen E Cashman","ppno":"6038683300","pcpadd":"65 Calef Hwy, Ste 200","pcpcity":"Lee","pcpstate":"NH","pcpzip":"03861","pcpcounty":"","pcpid":"","pcpname":"Wentworth Douglass Physician Corp","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - NH - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"473 OLD ROCHESTER RD","madd2":"","madd3":"","mcity":"SOMERSWORTH","mstate":"NH","mzip":"03878","pcpfaxno":"","pcpnpi":"1720156367","currentgendcomment":"","pphycomment":"","uniqueid":"147665300","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","M47816","Z8551","Z853","M5134","M549","J101","R509","E559","C73","E890","M85852","E2839","M8580","Z780","Z1231","C50911","Z114","Z1159","Z0000","F17210","Z20822","R062","R350","Z23","F419","M810","G4709","H6123","R197","F32A","R5381","R0683","R5383"],"date":["2026-02-20","2025-01-03","2025-01-03","2025-01-03","2025-01-03","2025-01-03","2025-02-05","2025-01-28","2025-05-02","2025-05-02","2025-05-27","2025-03-19","2025-03-19","2025-05-02","2025-05-02","2025-03-24","2025-05-01","2025-05-02","2025-05-02","2025-05-27","2025-01-28","2025-01-28","2025-02-05","2025-05-27","2025-05-27","2026-01-05","2025-05-27","2026-01-05","2025-05-27","2025-05-27","2026-01-05","2026-01-05","2026-01-05","2026-01-05"],"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":[["","","LORAZEPAM","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ESZOPICLONE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","ANASTROZOLE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","Select","Select",""],["","","BUPROPION XL","","","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":""}]}]}