{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jennifer White","gend":1,"currentgend":"","add":"305 TURNPIKE ST TRLR 305","city":"SOUTH EASTON","state":"MA","zip":"02375","dob":"1980-12-02","age":"","mstatus":"","insh":"C0008978500","cliId":"","pno":"7817608596","cno":"","email":"","ename":"","eno":"","pphy":"Penelope  Kagan","ppno":"5088976040","pcpadd":"1 Pearl St, Ste 2100","pcpcity":"Brockton","pcpstate":"MA","pcpzip":"02301","pcpcounty":"","pcpid":"","pcpname":"Revere Medical of Massachusetts, P.C.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"305 TURNPIKE ST TRLR 305","madd2":"","madd3":"","mcity":"SOUTH EASTON","mstate":"MA","mzip":"02375","pcpfaxno":"","pcpnpi":"1194341008","currentgendcomment":"","pphycomment":"","uniqueid":"68412550","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":["E876","R99","E785","I10","M5450","M542","B001","G8929","Z1211","D122","D124","K621","K648","D123","K5730","E669","N926","F17200","B002","M5412","M461","M5459","F17290","Z0101","Z0001","L719","Z1331","Z1283","T43295A","Z87891","Z720","M545","Z1231","Z0000","Z1239","Z131","H40053","H40003","Z803"],"date":["2026-05-20","2026-04-01","2026-04-25","2026-05-20","2026-02-18","2026-02-05","2026-02-18","2026-05-13","2026-04-09","2026-04-13","2026-04-13","2026-04-13","2026-04-09","2026-04-13","2026-04-09","2026-02-18","2025-07-17","2025-07-01","2025-07-01","2026-01-05","2025-10-20","2025-10-20","2025-10-15","2026-02-03","2026-02-18","2026-02-18","2026-02-18","2026-02-18","2026-02-18","2026-02-18","2025-02-24","2025-03-16","2025-05-07","2025-02-13","2025-02-13","2025-02-13","2025-03-24","2025-03-24","2025-05-07"],"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":[["","","POTASSIUM CHLORIDE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","NICOTINE PATCH","","","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":""}]}]}