{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Janine Sawyer-Standley","gend":1,"currentgend":"","add":"40 Aspen Dr","city":"Atkinson","state":"NH","zip":"03811","dob":"1961-06-20","age":"","mstatus":"","insh":61000151800,"cliId":"","pno":"6035527387","cno":"","email":"","ename":"","eno":"","pphy":"Amanda C Carrozza","ppno":"6033824972","pcpadd":"127 Plaistow Rd","pcpcity":"Plaistow","pcpstate":"NH","pcpzip":"03865","pcpcounty":"","pcpid":"","pcpname":"Core Physicians, LLC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - NH - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"40 Aspen Dr","madd2":"","madd3":"","mcity":"Atkinson","mstate":"NH","mzip":"03811","pcpfaxno":"","pcpnpi":"1730447772","currentgendcomment":"","pphycomment":"","uniqueid":"148606550","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","J189","B370","L249","J0101","F32A","K219","F411","R9389","J069","H6991","J040","J029","H9201","R0602","R918","R053","J0190","Z885","Z882","J984","Z20822","R051","Z1231","L309","L578","L814","I788","L821","D2262","Z08","Z85828","Z79899","T63463A","Z0000","R7301","I10","E538","F419","F3341","M940","E782","Z8742","Z6822","Z01419","R519"],"date":["2025-09-24","2025-03-02","2025-03-02","2025-07-29","2025-12-05","2025-12-05","2025-12-09","2026-02-24","2025-03-21","2025-02-25","2025-02-21","2025-02-21","2025-04-08","2025-02-21","2025-02-25","2025-02-25","2025-02-25","2025-11-28","2025-03-29","2025-03-29","2025-03-21","2025-03-29","2025-11-28","2025-07-16","2025-07-29","2025-07-29","2025-07-29","2025-07-29","2025-07-29","2025-07-29","2025-07-29","2025-07-29","2025-07-29","2025-08-15","2025-09-24","2025-09-08","2025-09-08","2025-09-08","2025-09-24","2025-09-24","2025-09-24","2025-09-24","2025-09-24","2025-09-24","2025-09-30","2025-11-28"],"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":[["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","CLOTRIMAZOLE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","HALOBETASOL PROPIONATE","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","OMEPRAZOLE","","","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":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"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":""}]}]}