{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Krystal L Salvatore","gend":1,"currentgend":"","add":"35 Potter Street","city":"South Dartmouth","state":"MA","zip":"02748","dob":"1989-05-19","age":"","mstatus":"","insh":"C0018772100","cliId":"","pno":"5088132020","cno":"","email":"","ename":"","eno":"","pphy":"Stephen  Finney","ppno":"5089732216","pcpadd":"500 Faunce Corner Rd, Ste 170","pcpcity":"North Dartmouth","pcpstate":"MA","pcpzip":"02747","pcpcounty":"","pcpid":"","pcpname":"Southcoast Physicians Group, Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"35 Potter Street","madd2":"","madd3":"","mcity":"South Dartmouth","mstate":"MA","mzip":"02748","pcpfaxno":"","pcpnpi":"1386105351","currentgendcomment":"","pphycomment":"","uniqueid":"95776600","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":["Z124","Z01419","R87810","Z6834","E66811","E661","Z713","Z6833","Z7182","F3181","K219","F900","E785","R87610","S161XXA","S39012A","F4312","F410","Z79899","F3170","K920","Z720","R109","R1012","R1013","R1011","M25511","G8929","Z1331","Z0000","E559","M7581","S4351XD","K760","Z87891","R99","B353","Z981","J4520","M549","Z1151","S29012A","M542","R1110","K828","Z3202","E6609","Z1159","R7989","F4310","F909","E669","F17210","K2100","K2950","E66812","Z6835","H6991","J029","M25561","R112"],"date":["2025-08-15","2025-08-15","2025-08-15","2025-08-15","2026-05-12","2025-09-03","2026-05-12","2026-05-12","2026-05-12","2026-05-12","2025-09-03","2026-05-28","2025-09-03","2025-08-15","2025-12-07","2025-12-07","2026-04-20","2026-04-20","2026-04-20","2026-05-11","2026-04-15","2026-04-15","2026-04-15","2026-04-15","2026-04-15","2026-04-15","2026-05-01","2026-05-01","2026-05-12","2026-05-12","2026-05-12","2026-05-12","2026-05-12","2026-05-12","2026-05-12","2026-05-08","2026-05-22","2026-01-30","2026-02-10","2026-04-06","2025-08-15","2025-12-07","2026-01-30","2026-04-15","2026-04-15","2026-04-15","2025-05-15","2025-05-15","2025-06-17","2024-09-10","2025-03-04","2024-09-20","2024-08-13","2024-10-15","2024-10-15","2025-01-13","2024-10-24","2025-02-03","2025-02-01","2025-05-15","2025-03-27"],"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":[["","","NICOTINE PATCH","","","Select","Select",""],["","","NICOTINE GUM","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","ARIPIPRAZOLE","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","VYVANSE","","","Select","Select",""],["","","LISDEXAMFETAMINE DIMESYLATE","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","OLANZAPINE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","TERBINAFINE HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","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":""}]}]}