{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"William K Lablue","gend":0,"currentgend":"","add":"35 ROCK ST","city":"AVON","state":"MA","zip":"02322","dob":"1985-07-18","age":"","mstatus":"","insh":"C0007620800","cliId":"","pno":"6176457386","cno":"","email":"","ename":"","eno":"","pphy":"Simret  Tesfe","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":"35 ROCK ST","madd2":"","madd3":"","mcity":"AVON","mstate":"MA","mzip":"02322","pcpfaxno":"","pcpnpi":"1881879591","currentgendcomment":"","pphycomment":"","uniqueid":"66953700","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","G501","M5450","M542","M25512","M25511","J341","J323","Z0000","M65252","Z1211","Z1212","Z98890","K219","F419","I10","Z135","M5126","M47816","M48061","M546","R2689","H5711","J328","Z881","Z8249","Z808","M47812","M7912","Z1389","M2550","H9201","F32A","H11121","L718","H02883","H02886","H0289","H179","R519","J3489","R040","E785","Z125","H04123","H0259","Z113","Q759"],"date":["2026-05-22","2026-03-06","2026-04-10","2026-03-03","2025-07-01","2025-07-01","2026-03-06","2025-10-23","2025-08-01","2025-09-18","2025-09-12","2025-09-12","2026-03-06","2025-09-16","2026-04-10","2025-09-18","2025-11-14","2025-11-14","2026-05-13","2025-11-14","2026-03-03","2026-03-03","2025-09-16","2025-09-19","2026-01-23","2026-01-23","2025-10-16","2025-11-20","2025-11-20","2025-11-14","2025-12-18","2026-02-27","2026-04-10","2025-02-13","2024-12-10","2024-12-10","2024-12-10","2024-12-10","2024-12-10","2025-02-25","2025-04-14","2025-01-17","2025-05-22","2025-01-11","2025-02-13","2025-02-13","2025-01-11","2025-04-14"],"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":[["","","ERYTHROMYCIN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","KETOROLAC TROMETHAMINE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","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":""}]}]}