{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Megan E Dermody","gend":1,"currentgend":"","add":"598 SPRINGFIELD ST","city":"FEEDING HILLS","state":"MA","zip":"01030","dob":"1990-09-16","age":"","mstatus":"","insh":"C0015942100","cliId":"","pno":"4132705942","cno":"","email":"","ename":"","eno":"","pphy":"Shersten  Killip","ppno":"4135868400","pcpadd":"70 Main St","pcpcity":"Florence","pcpstate":"MA","pcpzip":"01062","pcpcounty":"","pcpid":"","pcpname":"Valley Medical Group, P.C.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"598 SPRINGFIELD ST","madd2":"","madd3":"","mcity":"FEEDING HILLS","mstate":"MA","mzip":"01030","pcpfaxno":"","pcpnpi":"1912933128","currentgendcomment":"","pphycomment":"","uniqueid":"89862300","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":["Z3041","G4700","R062","J069","R051","J028","J208","R99","K047","Z124","Z1151","R1030","M5450","N888","R519","Z1152","N72","Z8742","Z3202","Z0000","Z1331","Z1339","Z1159","E6601","R109","R1084","M5416","R102","N859","J0100","J45998","R87810","M7989","B349","R21","R509","M7910","M542","H9201","R112"],"date":["2026-01-16","2025-12-10","2025-08-19","2025-01-16","2025-04-11","2025-06-15","2025-06-15","2025-08-16","2025-08-20","2025-06-26","2024-04-26","2024-08-27","2024-09-12","2024-08-27","2025-08-16","2025-08-16","2025-09-19","2025-09-19","2025-09-19","2025-05-07","2025-05-07","2025-05-07","2024-04-26","2024-04-26","2024-08-27","2024-08-27","2024-09-30","2024-08-27","2024-08-27","2025-04-11","2025-04-11","2025-06-26","2025-08-13","2025-08-14","2025-08-16","2025-08-16","2025-08-16","2025-08-16","2025-08-16","2025-08-16"],"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":[["","","TRI-LO-MARZIA","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","PROCHLORPERAZINE MALEATE","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","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":""}]}]}