{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jeong O Wayner","gend":1,"currentgend":"","add":"131 HATHAWAY ST","city":"NEW BEDFORD","state":"MA","zip":"02746","dob":"1976-04-04","age":"","mstatus":"","insh":"C0015632800","cliId":"","pno":"5088177885","cno":"","email":"","ename":"","eno":"","pphy":"Theophilus V Addo","ppno":"5089963991","pcpadd":"531 Faunce Corner Rd","pcpcity":"North Dartmouth","pcpstate":"MA","pcpzip":"02747","pcpcounty":"","pcpid":"","pcpname":"Lifespan Physician Group of Massachusetts, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"APT 3W","add3":"","madd1":"131 HATHAWAY ST","madd2":"APT 3W","madd3":"","mcity":"NEW BEDFORD","mstate":"MA","mzip":"02746","pcpfaxno":"","pcpnpi":"1750479283","currentgendcomment":"","pphycomment":"","uniqueid":"89256000","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":["I10","Z1211","K621","Z87891","D649","R011","D72829","E559","F5104","J309","K5909","M542","N209","Z6834","J45909","K219","Z01419","Z760","Z1231","D128","Z0001","Z1331","N200","Q6101","R311","R3129","N2889","Z7689","N390","R399","N281","Z124","Z3041","N9410","J3089","G8929","R3121","R99"],"date":["2026-02-03","2024-09-11","2024-04-19","2024-04-19","2024-04-19","2024-04-19","2025-08-20","2025-11-06","2025-08-20","2025-08-20","2025-11-06","2026-01-03","2025-08-20","2025-11-06","2025-08-20","2025-11-17","2025-10-06","2025-09-02","2025-05-09","2024-04-22","2024-12-20","2025-08-20","2026-02-10","2025-01-29","2025-01-29","2025-05-14","2026-02-10","2025-05-14","2025-08-15","2025-08-06","2025-05-03","2025-10-06","2025-12-27","2025-10-06","2025-11-06","2025-11-06","2026-02-10","2025-10-27"],"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":[["","","APRI","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","AFLURIA TRIV 2024-25 (3YR UP)","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","JUNEL FE","","","Select","Select",""],["","","COMIRNATY 2025-2026 (12Y UP)","","","Select","Select",""],["","","AFLURIA 2025-2026 (3YR UP)","","","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":""}]}]}