{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Stella J Damelio Noonan","gend":1,"currentgend":"","add":"150 WILLIAMS AVE","city":"POCASSET","state":"MA","zip":"02559","dob":"2004-11-07","age":"","mstatus":"","insh":"C0011718201","cliId":"","pno":"5082740340","cno":"","email":"","ename":"","eno":"","pphy":"Marie  Kayton","ppno":"5084775306","pcpadd":"55 Route 130","pcpcity":"Forestdale","pcpstate":"MA","pcpzip":"02644","pcpcounty":"","pcpid":"","pcpname":"Cape Cod Pediatrics, LLC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"150 WILLIAMS AVE","madd2":"","madd3":"","mcity":"POCASSET","mstate":"MA","mzip":"02559","pcpfaxno":"","pcpnpi":"1174794523","currentgendcomment":"","pphycomment":"","uniqueid":"71279101","medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J4520","J0190","F411","R99","F419","R0602","R0789","R000","J45909","F17210","F17200","R079","R55","R001","J069","L259","Z113","Z0000","Z130"],"date":["2025-09-23","2024-12-10","2025-09-24","2025-11-02","2024-10-14","2024-10-14","2025-05-25","2024-10-14","2025-05-25","2025-05-25","2024-10-17","2025-05-25","2025-05-25","2025-05-25","2025-09-21","2025-09-21","2025-09-23","2025-09-23","2025-09-23"],"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":[["","","VENTOLIN HFA","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","DICYCLOMINE HCL","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","NICOTINE LOZENGE","","","Select","Select",""],["","","PRAMIPEXOLE DIHYDROCHLORIDE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HYDROCORT","","","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":""}]}]}