{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Peter J Connolly","gend":0,"currentgend":"","add":"7 Young Terrace","city":"Norton","state":"MA","zip":"02766","dob":"1967-08-02","age":"","mstatus":"","insh":"C0020971000","cliId":"","pno":"5086221352","cno":"","email":"","ename":"","eno":"","pphy":"Rajani K Mallick","ppno":"5082859500","pcpadd":"14 Taunton Ave","pcpcity":"Norton","pcpstate":"MA","pcpzip":"02766","pcpcounty":"","pcpid":"","pcpname":"Sturdy Memorial Associates, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"7 Young Terrace","madd2":"","madd3":"","mcity":"Norton","mstate":"MA","mzip":"02766","pcpfaxno":"","pcpnpi":"1366454076","currentgendcomment":"","pphycomment":"","uniqueid":"100112350","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":["F1120","R99","Z0000","J449","E7849","E039","R7303","Z87891","Z87898","Z125","Z122","F1111","M1712","M25562","R0789","K2960","R030","J209","Z139","Z0001","Z23","E038","H35363","H52223","H524","R051","Z1389","R0981","Z1331","G4739","J441","J329","N528","R059","G4730","F1121","M26629","L309","Z1211","K635","K648","B182","E785","Z8616","Z86010","Z79899","Z79890","Z136","M26622","K029","M2559","Z8249"],"date":["2026-05-25","2026-05-20","2025-11-21","2025-11-21","2025-11-21","2025-11-21","2025-11-21","2026-01-19","2025-11-21","2025-11-21","2026-01-19","2026-05-05","2025-09-06","2025-11-21","2025-07-07","2025-08-05","2025-11-21","2025-07-20","2025-11-21","2025-11-21","2025-11-21","2025-11-21","2026-03-28","2026-03-28","2026-03-28","2024-11-01","2024-11-19","2024-11-01","2024-11-19","2024-11-19","2024-11-19","2025-05-21","2025-05-21","2024-11-01","2024-11-19","2024-02-14","2024-03-30","2024-05-04","2024-04-26","2024-04-26","2024-04-26","2024-04-26","2024-04-26","2024-04-26","2024-04-26","2024-04-26","2024-04-26","2024-06-06","2024-03-30","2024-09-04","2024-06-05","2024-06-06"],"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":[["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","BUPRENORPHINE-NALOXONE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","VITAMIN D2","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","NABUMETONE","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","IBUPROFEN","","","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":""}]}]}