{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Carissa Phillips","gend":1,"currentgend":"","add":"200 PARK ST","city":"ATTLEBORO","state":"MA","zip":"02703","dob":"1981-12-28","age":"","mstatus":"","insh":"C0019694600","cliId":"","pno":"5085810587","cno":"","email":"","ename":"","eno":"","pphy":"Ahmad M Rana","ppno":"5086959421","pcpadd":"170 Draper Ave","pcpcity":"North Attleboro","pcpstate":"MA","pcpzip":"02760","pcpcounty":"","pcpid":"","pcpname":"Sturdy Memorial Associates, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"APT 207","add3":"","madd1":"200 PARK ST","madd2":"APT 207","madd3":"","mcity":"ATTLEBORO","mstate":"MA","mzip":"02703","pcpfaxno":"","pcpnpi":"1417054222","currentgendcomment":"","pphycomment":"","uniqueid":"97672150","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","N200","R059","H6501","K5000","R300","N136","B9561","F32A","E66812","G2581","K5090","F419","Z6838","Z87442","Z87891","Z0000","Z6839","L309","E559","R5383","N926","Z01419","N951","Z8041","F411","F331","R454","F5102","F509","R41840","Z6837","M7711","F418","N132","R10A1","N201","E669","J040","R112","N1330","Z124","D2371","D2261","L814","L821","Z7189","F909","E538","N939","Z01411","Z09","R739","R54","R928","L400","F424","L578","Z79890","H524","K635","K5790","K649","K5730","D122","K8020","R109","R1011","R1110","Z0389","R1010","K5010","K5901","R001","R1013","R0602","R079","R1084","F17290","Z79899","Z0001","Z23","Z1331","R935","R92321","R0609","K219","G4730","L408","F988","N959","F329","Z6841","Z91011","K50912","Z91148","Z91199","Z8616","Z7985","K648","K319","K120"],"date":["2026-05-20","2026-02-12","2026-02-06","2026-02-06","2026-03-19","2025-12-16","2026-01-19","2026-01-19","2026-01-19","2026-04-02","2026-01-19","2026-04-02","2026-03-19","2026-01-19","2026-01-19","2026-01-19","2026-03-19","2026-04-02","2026-03-19","2026-04-02","2026-03-19","2026-03-19","2026-04-16","2026-04-16","2026-04-16","2026-04-07","2026-04-07","2026-04-07","2026-04-07","2025-08-11","2025-08-11","2025-12-16","2025-12-16","2026-04-02","2026-01-20","2026-01-19","2026-01-20","2026-01-20","2026-02-06","2026-01-19","2026-01-22","2026-03-19","2026-04-10","2026-04-10","2026-04-10","2026-04-10","2026-04-10","2026-04-02","2026-04-02","2026-04-09","2026-04-16","2025-05-01","2025-05-01","2025-04-04","2024-09-17","2024-09-24","2024-09-24","2024-09-24","2025-04-26","2024-10-15","2025-03-09","2024-11-21","2024-11-21","2024-11-21","2024-11-22","2025-03-09","2025-03-23","2025-03-25","2025-03-12","2025-03-15","2025-03-21","2025-03-23","2025-03-23","2025-03-21","2025-03-25","2025-03-25","2025-03-25","2025-03-10","2025-03-25","2025-03-25","2025-06-16","2025-06-16","2025-06-16","2024-09-03","2024-09-17","2025-03-23","2025-03-23","2025-03-23","2025-03-23","2025-03-23","2025-03-23","2025-03-23","2025-03-23","2025-03-23","2025-03-09","2025-03-09","2025-03-09","2025-03-09","2025-03-09","2025-03-09","2025-03-09","2025-03-09"],"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":[["","","TOPIRAMATE","","","Select","Select",""],["","","ESTRADIOL (TWICE WEEKLY)","","","Select","Select",""],["","","PROGESTERONE","","","Select","Select",""],["","","SUPREP","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","BUDESONIDE EC","","","Select","Select",""],["","","SUCRALFATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHETAMINE","","","Select","Select",""],["","","PHENTERMINE HCL","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","SKYRIZI ON-BODY","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","HALOBETASOL PROPIONATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","CEFUROXIME","","","Select","Select",""],["","","OXYBUTYNIN CHLORIDE","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","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":""}]}]}