{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Euphemia V Jones","gend":1,"currentgend":"","add":"296 MENLO ST","city":"BROCKTON","state":"MA","zip":"02301","dob":"1965-07-03","age":"","mstatus":"","insh":"C0006675200","cliId":"","pno":"5089416624","cno":"","email":"","ename":"","eno":"","pphy":"Daniel  Feleke","ppno":"5088940400","pcpadd":"110 Liberty St","pcpcity":"Brockton","pcpstate":"MA","pcpzip":"02301","pcpcounty":"","pcpid":"","pcpname":"Signature Healthcare Medical Group, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"296 MENLO ST","madd2":"","madd3":"","mcity":"BROCKTON","mstate":"MA","mzip":"02301","pcpfaxno":"","pcpnpi":"1598905630","currentgendcomment":"","pphycomment":"","uniqueid":"66317600","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","E039","I10","E0500","Z0000","E785","K5900","R7989","Z23","Z1231","S62633D","S68123A","S61319D","S62603D","E663","Z6828","M20092","S62663S","S62603A","S62607D","S61319A","Z973","Z8249","S62633B","W07XXXA","S62633G","M7989","S62663B","S61203A","I480","M25511","R0789","Z131","Z1151","Z01419","R928","N6310","Z79899","Z1211","D122","K648","N6311","N6489","H0520","J189","E890","S4991XA","Z124","R921","K640","N6312","Z09","Z833","K635","K649","H25013","H47093","H04123","R768","H5051","H524","Z823"],"date":["2026-04-29","2026-04-02","2026-02-12","2026-04-28","2025-10-06","2026-02-12","2025-10-06","2026-03-12","2025-10-06","2025-11-07","2026-02-02","2026-02-13","2026-01-27","2026-01-27","2026-01-27","2026-01-27","2026-02-10","2026-02-10","2026-02-25","2026-03-26","2026-01-27","2026-02-10","2026-02-10","2026-02-02","2026-02-02","2026-02-02","2026-02-02","2026-02-10","2026-02-12","2026-02-12","2024-07-12","2024-12-10","2024-08-09","2024-10-18","2024-10-18","2025-03-28","2024-12-03","2024-12-10","2025-03-19","2025-03-19","2025-03-19","2025-03-28","2025-03-28","2025-04-02","2025-05-16","2025-06-25","2024-07-12","2024-10-18","2024-11-06","2025-03-19","2025-03-28","2025-03-28","2025-06-12","2025-03-19","2025-03-19","2025-06-12","2025-06-12","2025-06-12","2025-06-12","2025-06-12","2025-06-12","2025-06-12"],"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":[["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","VIVOTIF","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","IBUPROFEN","","","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":""}]}]}