{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Paul G Forrest","gend":0,"currentgend":"","add":"36 poplar rd","city":"Brockton","state":"MA","zip":"02301","dob":"1968-05-20","age":"","mstatus":"","insh":"C0020598000","cliId":"","pno":"5084687029","cno":"","email":"","ename":"","eno":"","pphy":"Kateri I McCarthy","ppno":"5085596699","pcpadd":"63 Main St","pcpcity":"Brockton","pcpstate":"MA","pcpzip":"02301","pcpcounty":"","pcpid":"","pcpname":"Brockton Neighborhood Health Center","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"Apt 3","add3":"","madd1":"36 poplar rd","madd2":"Apt 3","madd3":"","mcity":"Brockton","mstate":"MA","mzip":"02301","pcpfaxno":"","pcpnpi":"1013337088","currentgendcomment":"","pphycomment":"","uniqueid":"99565000","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","E1122","M47816","I25110","I5033","N179","I6381","I871","Z981","Z95810","Z955","Z951","Z87891","Z8673","Z7984","Z7982","Z794","Z7902","I252","N189","Z79899","E1140","E785","I130","I160","I5030","Z4502","I429","T25322A","T25321A","L03115","I2510","L03116","E1151","I10","G4733","Z89412","E11621","T25322D","T25321D","E1142","R234","E119","M25521","I25810","L97522","L97512","T8744","E1169","M86172","N170","L97519","L97529","N1832","J449","Z89411","B951","B9562","B965","I129","T25022S","T25021S","Z45010","M869","L97426","M7989","M7732","Z59869","E669","I5032","E11628","Z950","Z6839","N1831","E1159","Z4889","L84","M79672","R2689","R2681","M5450","F332","F419","Z87898","Z98890","M533","M7918","R0602","R55","S299XXA","S3991XA","S3993XA","R0789","W19XXXA","I808","R2232","S0990XA","S20219A","R9401","J948","R509","Z09","Z760","M5412","F3289","R399","M5442","M5441","G8929","R350","H5213","E113292","H52203","H524","Z96652","M86672","I200","L97511","L97521","X19XXXA","Y93G3","Y92833","T25022A","T25021A","Z713","Z7182","D649","S91302A","R200","S91301A","I509","Z1211","N289","R2243","L0390","R809","L97524","R600","L97514","M868X7","Z5181","Z89422","E781","S93145A","M7752","R2242","L089","M7701","M7711","I110","S93125A","M85872","S98112A","E782","E66813","Z6841","G4761","M25532","M25522","M25422","Z23","E6601","G4701","J309","I69328","M4316","Z8679","M461","S7002XA","N529","N5201","J45909","E559","M654","M7022","S76819S","G5703","M4326","M797","L639","J4540","Z8249","Z91018","S66911A","S40022A","S86811A","J4550"],"date":["2026-05-29","2026-05-29","2025-11-25","2025-09-09","2026-02-05","2025-11-11","2025-09-07","2025-10-22","2026-04-17","2026-02-05","2025-11-06","2026-02-05","2026-02-05","2026-02-05","2025-12-02","2025-09-07","2026-03-19","2026-02-05","2026-02-05","2026-02-12","2025-10-02","2026-03-12","2026-02-05","2026-02-05","2025-10-02","2025-09-07","2026-03-22","2025-09-06","2025-10-02","2025-10-02","2025-10-02","2026-02-05","2026-01-06","2026-01-06","2026-03-19","2026-01-06","2026-01-08","2026-03-12","2025-10-09","2025-10-09","2025-11-05","2025-10-09","2025-12-03","2025-10-20","2026-02-05","2025-12-30","2026-03-12","2025-11-05","2026-01-08","2026-01-06","2025-11-05","2025-11-05","2026-01-06","2026-01-06","2026-01-06","2025-11-05","2025-11-05","2025-11-05","2025-11-05","2025-11-05","2025-11-05","2025-11-05","2025-12-16","2026-01-08","2026-01-08","2025-12-30","2026-01-05","2026-01-06","2026-01-06","2026-01-06","2026-01-15","2026-01-06","2026-01-06","2026-03-19","2026-02-05","2026-02-19","2026-01-22","2026-03-27","2026-03-27","2026-03-27","2026-04-17","2026-04-24","2026-04-24","2026-04-24","2026-04-24","2025-11-25","2025-11-25","2025-09-07","2025-12-03","2025-09-07","2025-09-07","2025-09-07","2025-09-07","2025-09-07","2025-09-12","2025-09-10","2025-09-12","2025-09-07","2025-09-09","2025-09-12","2025-09-12","2025-11-20","2025-09-30","2026-04-30","2026-03-04","2026-03-12","2026-04-01","2026-04-01","2026-04-01","2026-02-12","2026-04-16","2026-04-16","2026-04-16","2026-04-16","2026-01-09","2026-01-08","2025-09-09","2025-12-19","2025-12-30","2025-10-01","2025-10-01","2025-10-01","2025-10-01","2025-10-01","2026-01-15","2026-01-15","2025-10-30","2025-09-30","2025-09-30","2025-09-30","2026-01-08","2025-10-30","2025-11-03","2025-10-01","2026-01-09","2025-11-11","2025-11-10","2025-11-05","2025-11-07","2026-01-05","2025-12-15","2026-01-06","2025-12-03","2025-11-06","2025-11-06","2026-01-05","2026-01-15","2025-12-17","2025-12-17","2026-01-08","2026-01-05","2025-12-30","2026-03-19","2026-03-19","2026-03-19","2026-03-19","2024-07-01","2024-07-22","2024-08-03","2024-08-03","2025-01-09","2024-09-03","2024-08-09","2024-08-09","2024-08-09","2024-10-02","2025-06-03","2025-02-13","2025-02-20","2024-07-16","2024-07-23","2024-09-03","2024-07-23","2024-07-23","2024-08-02","2024-09-03","2024-09-03","2024-10-02","2025-02-20","2024-11-26","2025-01-09","2024-11-12","2024-11-26","2025-02-20","2025-02-20","2025-02-20","2025-02-20"],"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":[["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","BUTALBITAL-ACETAMINOPHEN-CAFFE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ISOSORBIDE MONONITRATE ER","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","FOLIC ACID","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","LINEZOLID","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","CLOPIDOGREL","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","HUMALOG KWIKPEN U-100","","","Select","Select",""],["","","MOUNJARO","","","Select","Select",""],["","","FREESTYLE LIBRE 3 PLUS SENSOR","","","Select","Select",""],["","","FREESTYLE LIBRE 3 READER","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","ERYTHROMYCIN","","","Select","Select",""],["","","AMITRIPTYLINE HCL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","VITAMIN D2","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","STIOLTO RESPIMAT","","","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":""}]}]}