{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Brandie L Eaton","gend":1,"currentgend":"","add":"31 HARTWELL DR","city":"EAST FALMOUTH","state":"MA","zip":"02536","dob":"1979-10-11","age":"","mstatus":"","insh":"C0017076800","cliId":"","pno":"7743927875","cno":"","email":"","ename":"","eno":"","pphy":"Benjamin R Levin","ppno":"5084955160","pcpadd":"21 Bramblebush Park","pcpcity":"Falmouth","pcpstate":"MA","pcpzip":"02540","pcpcounty":"","pcpid":"","pcpname":"Medical Affiliates of Cape Cod, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"31 HARTWELL DR","madd2":"","madd3":"","mcity":"EAST FALMOUTH","mstate":"MA","mzip":"02536","pcpfaxno":"","pcpnpi":"1356631436","currentgendcomment":"","pphycomment":"","uniqueid":"92632200","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":["R99","J4520","J029","J301","J302","J3089","J3081","J4550","J449","L409","L408","R059","E782","Z1231","Z01419","Q0700","J309","K589","E559","M1990","L4050","E739","F17200","R5383","Z13220","Z113","Z803","R92333","Z0000","Z1211","Z1212","M25512","M7522","M79602","J069","Z0100"],"date":["2026-04-20","2026-05-26","2026-04-04","2026-04-09","2026-04-09","2026-04-09","2026-04-09","2026-03-12","2026-03-12","2025-04-29","2025-04-29","2025-01-28","2025-04-25","2024-12-19","2024-07-05","2024-09-23","2024-09-23","2025-01-27","2025-01-27","2024-09-23","2024-09-23","2024-09-23","2024-09-23","2024-12-16","2024-12-16","2024-12-16","2024-12-19","2024-12-19","2025-01-27","2025-02-15","2025-02-15","2025-03-17","2025-03-24","2025-03-24","2024-11-04","2024-05-20"],"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":[["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","SPIRIVA RESPIMAT","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","FLUTICASONE PROPIONATE HFA","","","Select","Select",""],["","","VENTOLIN HFA","","","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":""}]}]}