{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"James Sannicandro","gend":0,"currentgend":"","add":"71 ELLISVILLE GRN","city":"PLYMOUTH","state":"MA","zip":"02360","dob":"1966-03-12","age":"","mstatus":"","insh":"C0019047700","cliId":"","pno":"5085271996","cno":"","email":"","ename":"","eno":"","pphy":"Fanny G Giron Galeano","ppno":"5084777090","pcpadd":"107 Commercial St","pcpcity":"Mashpee","pcpstate":"MA","pcpzip":"02649","pcpcounty":"","pcpid":"","pcpname":"Community Health Center of Cape Cod","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"71 ELLISVILLE GRN","madd2":"","madd3":"","mcity":"PLYMOUTH","mstate":"MA","mzip":"02360","pcpfaxno":"","pcpnpi":"1134626690","currentgendcomment":"","pphycomment":"","uniqueid":"96301700","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","I10","K029","Z122","F17210","E7800","K219","R0789","F419","F32A","M7918","R5382","I4589","E785","G4733","I2510","R053","F411","J302","R0602","M5431","M20011","M5432","S62660B","Z1211","D125","D123","D122","K529","R12","R319","J449","F1290","Z79899","Z7952","R310","N200","N399","L03011","T8141XA","S60410A","L089","M869","A491","R079","I454","Z0001","Z1389","Z139","F17200","Z0000","Z452","M86041","Z792","N390","M5117","M5116","M4316","R634","S67190A","X58XXXA","R3121","Z860100","K635","N400","M5450","T8149XA","M797"],"date":["2026-04-21","2026-04-14","2025-11-17","2025-07-16","2025-07-16","2025-07-31","2025-08-27","2025-08-27","2026-02-06","2026-02-06","2025-11-14","2025-11-14","2026-04-02","2026-04-02","2026-04-02","2026-04-02","2024-09-26","2024-07-25","2024-08-26","2025-04-01","2024-11-15","2025-01-27","2024-07-01","2024-09-26","2024-11-22","2024-11-22","2024-11-22","2024-11-22","2024-11-22","2024-11-22","2025-04-10","2025-03-18","2024-12-19","2025-01-30","2024-12-19","2025-03-14","2025-04-10","2025-01-22","2025-01-30","2025-01-30","2025-01-31","2025-01-31","2025-03-25","2025-02-20","2025-04-04","2025-04-01","2025-04-10","2025-04-10","2025-04-10","2025-04-10","2025-01-31","2025-01-31","2025-03-25","2025-03-16","2025-01-22","2024-07-01","2024-07-01","2024-07-01","2024-08-26","2024-09-26","2024-09-26","2024-11-14","2024-11-22","2024-11-22","2024-12-06","2024-11-15","2025-01-30","2025-01-30"],"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":[["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","BUPROPION HCL","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","LORAZEPAM","","","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":""}]}]}