{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kevin j Holmes","gend":0,"currentgend":"","add":"121 PLYMOUTH ST","city":"MIDDLEBORO","state":"MA","zip":"02346","dob":"1961-11-14","age":"","mstatus":"","insh":"C0019676900","cliId":"","pno":"7747668617","cno":"","email":"","ename":"","eno":"","pphy":"Jack M Kirichian","ppno":"5089477610","pcpadd":"511 W Grove St, Ste 201","pcpcity":"Middleboro","pcpstate":"MA","pcpzip":"02346","pcpcounty":"","pcpid":"","pcpname":"Revere Medical of Massachusetts, P.C.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"121 PLYMOUTH ST","madd2":"","madd3":"","mcity":"MIDDLEBORO","mstate":"MA","mzip":"02346","pcpfaxno":"","pcpnpi":"1538258199","currentgendcomment":"","pphycomment":"","uniqueid":"97663300","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":["E782","F411","R99","J449","N401","K219","K5732","Z122","Z87891","D485","R0609","F17200","Z0001","C44519","F418","Z9109","H6192","R3915","J341","L400","L570","Z760","J349","E785","R1013","J0100","F419","J329","R059","J320","R519","M542","R0989","G4700","Z0000","Z23","T7849XD","H938X2","F17210","J3089","Z743","L409","H903","H9313","J392","J3489","J342"],"date":["2026-05-05","2026-05-04","2026-04-02","2026-04-26","2026-03-30","2026-03-30","2026-05-22","2025-10-18","2025-11-20","2025-08-25","2025-11-20","2025-11-20","2025-11-14","2025-11-21","2025-11-07","2025-11-07","2025-11-07","2025-11-07","2025-11-07","2025-11-07","2026-03-06","2025-12-29","2024-07-13","2025-05-04","2025-06-14","2024-09-11","2025-02-14","2024-12-06","2024-12-06","2025-03-28","2025-04-18","2025-02-21","2025-04-18","2024-07-25","2024-10-24","2024-10-24","2025-06-06","2025-06-06","2024-11-09","2024-11-07","2025-02-21","2025-06-06","2025-04-18","2025-04-18","2025-04-18","2025-04-18","2025-04-18"],"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":[["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","PRAVASTATIN SODIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","NICOTINE PATCH","","","Select","Select",""],["","","NICOTINE LOZENGE","","","Select","Select",""],["","","ANORO ELLIPTA","","","Select","Select",""],["","","FLUBLOK 2025-2026","","","Select","Select",""],["","","TRELEGY ELLIPTA","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ACETAMINOPHEN-CODEINE","","","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":""}]}]}