{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Colleen Silvia","gend":1,"currentgend":"","add":"8 ANACONDA DR","city":"LAKEVILLE","state":"MA","zip":"02347","dob":"1962-10-01","age":"","mstatus":"","insh":"C0002221400","cliId":"","pno":7747668339,"cno":"","email":"","ename":"","eno":"","pphy":"Kara J Kopaczewski","ppno":5089732206,"pcpadd":"49 State Rd,","pcpcity":"North Dartmouth","pcpstate":"MA","pcpzip":"02747","pcpcounty":"","pcpid":"","pcpname":"Southcoast Physicians Group, Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"8 ANACONDA DR","madd2":"","madd3":"","mcity":"LAKEVILLE","mstate":"MA","mzip":"02347","pcpfaxno":"","pcpnpi":1215323852,"currentgendcomment":"","pphycomment":"","uniqueid":57876800,"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","F1090","B001","J069","F1020","E669","Z124","Z1151","Z1231","N951","I160","I10","R9431","Z87891","Z0000","E039","I2510","R55","R002","R300","G4733","Z1159","F509","F1021","R197","Z9884","E7800","M549","R0781","S2242XA","Z23","M8589","Z780","R519","R42","R0602","E66811","E6609","Z6832","R5383","T22012A","T300","E663","Z713","Z7182","R1032"],"date":["2025-12-26","2024-12-04","2025-11-25","2024-11-23","2025-03-25","2025-07-03","2024-06-21","2024-06-21","2025-07-28","2024-08-10","2024-10-17","2025-11-09","2024-10-14","2024-10-14","2025-12-09","2025-11-09","2025-02-13","2024-12-16","2025-02-13","2024-12-30","2025-11-27","2025-12-09","2024-02-04","2025-11-09","2024-02-27","2025-06-26","2025-11-09","2024-10-14","2024-09-27","2024-09-27","2025-02-01","2024-08-10","2024-08-10","2024-10-14","2024-10-14","2024-11-23","2025-02-01","2025-02-01","2025-02-01","2024-12-18","2025-10-04","2025-04-18","2025-11-12","2025-11-12","2025-11-12","2025-11-12"],"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":[["","","ZEPBOUND","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","CREON","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","VIVITROL","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","Select","Select",""],["","","SHINGRIX","","","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":""}]}]}