{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Darlene R Ducharme","gend":1,"currentgend":"","add":"29 BANGOR ST","city":"BROCKTON","state":"MA","zip":"02302","dob":"1969-11-09","age":"","mstatus":"","insh":"C0020067000","cliId":"","pno":"7742221080","cno":"","email":"","ename":"","eno":"","pphy":"Divjot K Sooch","ppno":"5088940400","pcpadd":"1215 Broadway","pcpcity":"Raynham","pcpstate":"MA","pcpzip":"02767","pcpcounty":"","pcpid":"","pcpname":"Signature Healthcare Medical Group, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"29 BANGOR ST","madd2":"","madd3":"","mcity":"BROCKTON","mstate":"MA","mzip":"02302","pcpfaxno":"","pcpnpi":"1275731853","currentgendcomment":"","pphycomment":"","uniqueid":"98803250","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":["Z0000","I10","J449","J439","F17210","Z803","K219","Z23","Z1331","Z8719","Z808","Z171","Z1231","K625","M546","M51362","M533","M25511","M7918","G894","Z79899","G8929","M25512","K921","R109","R197","R1110","E782","F17200","R000","Z98891","Z882","Z9851","D120","D122","D124","Z860101","K640","K5730","K635","Z09","K648","N83292","K7689","G603","L84","L603","Z973","Z8261","Z8709","Z1211","Z716","R99","M62830","M51360","Z79891","Z122","J441","R059","M19011","R92333","M810","E785","R7303","M51369","M461","Z860100","R0609","Z720","R918","H6091","M5136","M25521","M25531","M25532","Z5181","R0600","R030","Z0130","Z888","Z8249","Q6671","Q6672","Z98890","M21621","M21622","M21611","M21612","M7541","M2041","M2042","L600"],"date":["2025-11-20","2026-01-23","2026-05-07","2025-11-20","2026-02-19","2025-11-20","2025-11-20","2025-11-20","2025-11-20","2025-11-20","2025-11-20","2025-11-20","2025-11-10","2026-01-16","2026-05-07","2026-05-07","2026-05-07","2026-05-07","2026-05-07","2026-05-07","2026-05-07","2026-05-07","2026-05-07","2025-12-18","2026-01-16","2025-12-18","2025-12-18","2025-12-18","2025-12-18","2025-12-18","2026-02-19","2026-02-19","2026-01-05","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2026-01-23","2025-12-18","2025-12-18","2026-02-19","2026-02-19","2026-02-19","2026-02-19","2026-02-19","2026-02-19","2026-01-23","2025-08-17","2026-05-16","2025-07-31","2025-07-31","2026-05-07","2025-07-23","2025-10-13","2025-10-13","2025-11-20","2025-11-10","2025-11-20","2025-11-20","2025-11-20","2026-01-16","2026-05-07","2026-01-23","2025-07-22","2025-10-13","2025-10-13","2025-02-12","2024-09-09","2024-10-29","2024-10-29","2024-10-29","2024-12-20","2024-08-02","2025-02-12","2025-02-24","2024-08-02","2025-03-20","2025-01-23","2025-01-23","2025-02-12","2025-03-20","2025-03-20","2025-03-20","2025-03-20","2025-05-02","2025-05-22","2025-05-22","2025-05-22"],"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":[["","","VARENICLINE TARTRATE","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","STIOLTO RESPIMAT","","","Select","Select",""],["","","MORPHINE SULFATE ER","","","Select","Select",""],["","","CIPROFLOXACIN-DEXAMETHASONE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","LISINOPRIL","","","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":""}]}]}