{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kayla Bloom","gend":1,"currentgend":"","add":"72 Walnut Ave","city":"North Hampton","state":"NH","zip":"03862","dob":"1989-04-06","age":"","mstatus":"","insh":61035817100,"cliId":"","pno":"9789796624","cno":"","email":"","ename":"","eno":"","pphy":"Margaret G Woodward","ppno":"6037750000","pcpadd":"20 Hampton Road","pcpcity":"Exeter","pcpstate":"NH","pcpzip":"03833","pcpcounty":"","pcpid":"","pcpname":"Core Physicians, LLC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - NH - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"72 Walnut Ave","madd2":"","madd3":"","mcity":"North Hampton","mstate":"NH","mzip":"03862","pcpfaxno":"","pcpnpi":"1588169916","currentgendcomment":"","pphycomment":"","uniqueid":"149447600","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","R1013","F17210","Z79899","M533","N393","N3281","Z885","M0760","R1310","J351","A6920","D72829","R591","R232","R5382","E042","K50819","F331","F1021","N3642","R1032","Q159","R5381","R197","L401","M5442","R1011","L2089","H6691","J029","Z20822","R051","R32","K50919","R6884","E538","M79604","M79605","R221","M799","K219","R590","Z1331","Z1339","E559","K449","R4702"],"date":["2026-02-06","2025-03-23","2025-05-07","2026-01-07","2025-11-26","2025-05-23","2025-05-07","2025-05-07","2025-12-01","2025-12-22","2025-11-30","2025-12-17","2025-11-30","2025-11-30","2025-12-17","2025-12-17","2025-12-22","2026-01-12","2025-05-23","2025-05-23","2025-02-03","2025-03-04","2025-03-04","2025-03-04","2025-03-04","2025-03-25","2025-03-25","2025-03-23","2026-01-07","2025-04-11","2025-04-11","2025-04-11","2025-04-11","2025-05-07","2025-12-03","2025-11-13","2025-11-26","2025-11-26","2025-11-26","2025-12-03","2025-11-29","2026-01-07","2025-12-10","2025-12-17","2025-12-17","2025-12-17","2026-01-07","2025-12-22"],"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":[["","","FLUOXETINE HCL","","","Select","Select",""],["","","ARIPIPRAZOLE","","","Select","Select",""],["","","DUPIXENT PEN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ATOMOXETINE HCL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","GAVILYTE-G","","","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":""}]}]}