{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Sarah G Boudreau","gend":1,"currentgend":"","add":"12 FORSYTH AVE","city":"SOMERSET","state":"MA","zip":"02726","dob":"1974-07-22","age":"","mstatus":"","insh":"C0001064100","cliId":"","pno":"5086416284","cno":"","email":"","ename":"","eno":"","pphy":"Jacqueline T Draper","ppno":"5086365101","pcpadd":"827 American Legion Hwy, Ste 1004","pcpcity":"Westport","pcpstate":"MA","pcpzip":"02790","pcpcounty":"","pcpid":"","pcpname":"Southcoast Physicians Group, Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"12 FORSYTH AVE","madd2":"","madd3":"","mcity":"SOMERSET","mstate":"MA","mzip":"02726","pcpfaxno":"","pcpnpi":"1881008324","currentgendcomment":"","pphycomment":"","uniqueid":"56041700","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R99","E782","I10","J45909","Z87892","N630","R599","N6009","N6325","R590","D7589","K5720","E871","R188","Z880","Z888","D126","E6609","E7800","E781","E8339","E876","F419","K5900","K602","K649","L719","N946","Z79899","Z87891","Z6830","Z1152","K5730","Z860101","E66811","Z6831","F1010","Z0000","N6459","Z23","J4520","R928","R92323","R7989","Z713","Z7182","R109","R61","R110","I700","R935","K449","Z452","K838","R1032","K5780","K5792","Z860100","Z09","Z1159","N6311"],"date":["2025-09-12","2026-02-19","2025-12-15","2025-04-09","2025-03-13","2024-08-06","2024-08-06","2024-08-06","2026-01-27","2026-01-27","2025-03-13","2025-04-28","2025-04-09","2025-04-09","2025-04-09","2025-04-09","2025-04-09","2025-04-09","2025-04-09","2025-04-09","2025-04-09","2025-04-09","2025-12-01","2025-04-09","2025-04-09","2025-04-09","2025-04-09","2025-04-09","2025-04-09","2025-06-11","2025-04-09","2025-04-09","2025-06-11","2025-06-11","2025-06-11","2025-06-11","2025-03-13","2024-11-05","2025-01-27","2024-11-05","2025-03-13","2026-01-27","2026-01-27","2025-03-13","2025-03-13","2025-03-13","2025-04-09","2025-04-15","2025-04-09","2025-04-09","2025-04-11","2025-04-11","2025-04-15","2025-04-15","2025-04-15","2025-04-20","2025-05-01","2025-05-01","2025-04-28","2025-04-28","2026-01-27"],"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":[["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","CHLORTHALIDONE","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","METRONIDAZOLE","","","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":""}]}]}