{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Diandra L Bergman","gend":1,"currentgend":"","add":"34 Priscilla Mullens Way","city":"Carver","state":"MA","zip":"02330","dob":"1963-07-22","age":"","mstatus":"","insh":"C0020167400","cliId":"","pno":"3398320315","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":"34 Priscilla Mullens Way","madd2":"","madd3":"","mcity":"Carver","mstate":"MA","mzip":"02330","pcpfaxno":"","pcpnpi":"1275731853","currentgendcomment":"","pphycomment":"","uniqueid":"98968350","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":["K5900","M549","Z1231","R92323","G459","F4310","M9903","K765","R195","R99","Z0100","R300","R0602","R399","R059","R0782","Z90710","Z98890","Z8249","Z1331","Z808","Z813","R079","E039","E785","J189","R1032","Z8261","K429","R932","M51379","M47816","M47817","F39","Z23","Z811","Z634","R9439","N390","Z0000","R5383","Z5181","E559","E875","F40240","F419","Z9882","M353","Z560","Z635","R509","Z5329","Z91018"],"date":["2026-03-31","2026-03-31","2026-03-03","2026-03-03","2026-04-06","2026-05-08","2026-05-12","2026-03-31","2026-03-31","2026-04-22","2025-02-14","2025-04-28","2025-02-28","2025-02-14","2025-02-14","2025-03-07","2025-05-08","2025-05-08","2025-05-14","2025-05-08","2025-02-14","2025-02-14","2025-02-24","2025-05-08","2025-05-14","2025-02-28","2025-04-14","2025-02-28","2025-04-14","2025-04-14","2025-04-14","2025-04-14","2025-04-14","2025-05-08","2025-05-08","2025-05-08","2025-05-08","2025-05-14","2024-11-13","2024-11-07","2024-11-07","2025-04-28","2024-11-07","2024-11-12","2025-02-07","2025-02-07","2025-01-24","2025-01-24","2025-02-06","2025-01-24","2025-01-30","2025-02-07","2025-02-06"],"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":[["","","CEPHALEXIN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","METHOCARBAMOL","","","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":""}]}]}