{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jennifer f Shaughnessy","gend":1,"currentgend":"","add":"1107 westgate st","city":"new bedford","state":"MA","zip":"02745","dob":"1979-10-31","age":"","mstatus":"","insh":"C0010400400","cliId":"","pno":"7749925981","cno":"","email":"","ename":"","eno":"","pphy":"Holly L Alexandre","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":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1107 westgate st","madd2":"","madd3":"","mcity":"new bedford","mstate":"MA","mzip":"02745","pcpfaxno":"","pcpnpi":"1922003334","currentgendcomment":"","pphycomment":"","uniqueid":"69885850","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":["R079","R112","R1013","F17290","F17210","R87610","R87810","R1084","M549","Z720","R062","D72829","Z1152","M5416","G8929","R1114","R110","M546","M5442","N12","Z3202","E1165","N390","R0789","F32A","F419","K219","Z79899","R109","M5450","N3941","N393","Z1231","M47816","R99","Z9049","K5730","N871","R7989","F3341","R002","R61","F17200","K30","F4323","I2489","R32","E119","R10A2","R001","K3184","M47817","M7918","K449","R1110","Z0000","F321"],"date":["2026-02-14","2026-03-26","2026-02-16","2026-03-26","2026-02-16","2025-07-31","2025-07-31","2025-09-28","2025-10-20","2025-09-28","2025-09-28","2026-02-12","2025-09-28","2025-10-20","2026-04-15","2025-11-12","2025-11-12","2026-04-15","2026-04-15","2026-02-17","2026-02-12","2026-04-15","2026-02-16","2026-02-16","2026-02-16","2026-04-15","2026-04-15","2026-02-16","2026-02-26","2026-03-26","2026-04-24","2026-04-24","2026-04-29","2026-05-01","2026-05-05","2025-08-03","2026-03-26","2025-07-31","2026-03-11","2025-10-17","2025-11-03","2025-11-03","2026-04-15","2026-02-17","2026-02-06","2026-02-17","2026-02-17","2026-03-26","2026-02-16","2026-02-15","2026-02-16","2026-03-31","2026-03-31","2026-03-26","2026-03-26","2026-04-15","2026-04-15"],"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":[["","","NORETHINDRONE","","","Select","Select",""],["","","COLESTIPOL HCL","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","TIZANIDINE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","GLIPIZIDE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","SLYND","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","PIOGLITAZONE HCL","","","Select","Select",""],["","","OMEPRAZOLE","","","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":""}]}]}