{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Tammy Martin","gend":1,"currentgend":"","add":"9 SURREY LN","city":"KINGSTON","state":"MA","zip":"02364","dob":"1973-11-03","age":"","mstatus":"","insh":"C0018268500","cliId":"","pno":"7742696682","cno":"","email":"","ename":"","eno":"","pphy":"Mary K Engel","ppno":"5087785470","pcpadd":"10 Cordage Park Cir","pcpcity":"Plymouth","pcpstate":"MA","pcpzip":"02360","pcpcounty":"","pcpid":"","pcpname":"Daniel Driscoll-Neponset Health Center","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"9 SURREY LN","madd2":"","madd3":"","mcity":"KINGSTON","mstate":"MA","mzip":"02364","pcpfaxno":"","pcpnpi":"1467643932","currentgendcomment":"","pphycomment":"","uniqueid":"94592550","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":["N202","M47816","S336XXA","M9904","M9902","R5383","R519","R0683","E611","E538","M9903","M9905","M533","G5603","J343","J384","H903","H9313","G4733","G4710","F5101","G4709","G932","F319","R3989","G43909","H47093","H47293","R269","S92355A","M79672","S92355D","S92902D","Z1331","Z780","D751","M797","F411","F330","S92352A","Z13820","M8589","G4700","R99","N200","Z0000","R350","Z23","R7303","E669","E7800","L732","Z1239","R300","Z124","E559","Z1159","M79642","Z1211","K2270","K635","Z9189","K5730","K648","K2970","J4530","K229","R011","M1611","R059","R062","M19042","K22719","K2289","K649","F17290","Z83719","M19049"],"date":["2025-10-01","2025-10-08","2025-10-08","2026-05-01","2026-05-01","2025-10-07","2025-10-07","2025-12-26","2025-10-07","2026-02-12","2026-05-01","2026-05-01","2025-12-05","2025-11-11","2025-10-29","2025-10-29","2025-10-29","2025-10-29","2026-05-02","2026-05-02","2025-10-29","2025-12-26","2025-11-11","2025-10-29","2025-11-05","2025-11-11","2025-11-11","2025-11-11","2025-11-11","2026-01-22","2026-05-13","2026-04-24","2026-05-06","2026-02-12","2026-05-06","2026-02-12","2026-03-10","2026-05-08","2026-05-08","2026-01-21","2026-05-06","2026-05-06","2026-05-02","2026-05-23","2025-09-26","2025-07-31","2025-07-31","2025-07-31","2025-08-02","2025-07-31","2025-08-02","2025-07-31","2025-07-31","2025-07-31","2025-07-31","2025-08-02","2025-08-02","2025-12-02","2025-03-20","2025-03-20","2025-03-20","2025-03-20","2025-03-20","2025-03-20","2025-03-20","2025-03-13","2025-03-20","2025-04-04","2025-04-04","2025-02-15","2025-02-15","2025-12-02","2025-03-20","2025-03-20","2025-03-20","2025-03-20","2025-03-20","2025-05-02"],"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":[["","","ATOMOXETINE HCL","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","OXCARBAZEPINE","","","Select","Select",""],["","","ARNUITY ELLIPTA","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","ACETAZOLAMIDE ER","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","PREGABALIN","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","MONTELUKAST SODIUM","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ASPIRIN EC","","","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":""}]}]}