{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michael S O'Keefe","gend":0,"currentgend":"","add":"48 WEATHERVANE WAY","city":"BREWSTER","state":"MA","zip":"02631","dob":"1961-04-21","age":"","mstatus":"","insh":"C0018710200","cliId":"","pno":7017304750,"cno":"","email":"","ename":"","eno":"","pphy":"Andrew Chin","ppno":5083493131,"pcpadd":"3130 State Hwy Rte 6,","pcpcity":"Wellfleet","pcpstate":"MA","pcpzip":"02667","pcpcounty":"","pcpid":"","pcpname":"Outer Cape Health Services","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"1421 orleans rd","madd2":"PMB 177","madd3":"","mcity":"Harwich","mstate":"MA","mzip":"02645","pcpfaxno":"","pcpnpi":1154889814,"currentgendcomment":"","pphycomment":"","uniqueid":95679650,"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","N281","K5730","C61","Z79899","M5450","G8929","M25551","M25552","M79651","M79652","J209","J0110","K5732","Z87891","B028","R10A2","Z7951","Z792","R109","Z9109","R062","T148XXA","Z923","Z0000","Z23","Z114","E7800","L821","S86911A","Z2821","R059","R5383","R0981","J22","J4540","R748","R899","R3914","N401","R7301","H5330","N400","K5792","K6389"],"date":["2025-12-14","2025-12-13","2025-06-12","2025-09-26","2025-12-13","2024-10-23","2024-10-23","2024-10-23","2024-10-23","2024-10-23","2024-10-23","2024-11-11","2024-11-11","2025-06-12","2025-12-13","2025-12-13","2025-12-13","2025-12-13","2025-12-13","2024-04-03","2024-04-03","2024-04-03","2024-04-03","2025-03-24","2025-04-04","2024-02-05","2024-02-05","2025-06-05","2024-02-05","2024-02-05","2024-10-17","2024-11-11","2024-11-11","2024-11-11","2024-10-12","2024-10-12","2024-10-12","2024-11-22","2025-10-03","2025-09-26","2025-06-05","2025-09-23","2025-06-12","2025-11-12","2025-12-13"],"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",""],["","","PREDNISONE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","SILODOSIN","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","VALACYCLOVIR","","","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":""}]}]}