{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nesreen Zakaria","gend":1,"currentgend":"","add":"250 WOODLAND AVE","city":"SEEKONK","state":"MA","zip":"02771","dob":"1981-08-10","age":"","mstatus":"","insh":"C0026125701","cliId":"","pno":4012488632,"cno":"","email":"","ename":"","eno":"","pphy":"Chadi Kaba","ppno":5083421101,"pcpadd":"100 Oneil Blvd,","pcpcity":"Attleboro","pcpstate":"MA","pcpzip":"02703","pcpcounty":"","pcpid":"","pcpname":"Sturdy Memorial Associates, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"250 WOODLAND AVE","madd2":"","madd3":"","mcity":"SEEKONK","mstate":"MA","mzip":"02771","pcpfaxno":"","pcpnpi":1811945694,"currentgendcomment":"","pphycomment":"","uniqueid":110533851,"medicareid":"","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J4520","Z6838","M797","Z7184","K589","Z23","J301","E66812","S060X0A","W182XXA","Z043","Y93E1","M5450","R0789","F0781","R519","M542","N6315","R99","K200","J020","E039","R9389","R590","D241","R1310","K219","Z1211","K5730","K648","K625","E785","E890","R7301","E6601","Z833","R591","Z0001","R92323","M50321","Z09","R92321","N951","Z9089","Z85850","R599","R928","J309","K5901","Z6837","F32A","E6609","R1312","Z7984","D360","R490","J392","K224","F331","F419","R12","R198","N6310","Z95810","Z1331","E7849","L219","M5416","M4802","M5030","M5031","M5116","J329"],"date":["2025-12-05","2025-12-05","2025-12-05","2025-12-05","2025-12-05","2025-12-05","2025-12-05","2025-12-05","2025-12-10","2025-12-10","2025-12-10","2025-12-10","2025-12-11","2025-10-16","2025-10-16","2025-10-16","2025-12-11","2025-10-28","2025-12-30","2025-10-04","2025-10-12","2025-03-14","2024-07-03","2024-12-18","2024-03-29","2024-09-19","2024-08-27","2024-09-19","2024-09-19","2024-09-19","2024-09-19","2024-10-24","2025-03-17","2025-02-20","2024-09-19","2024-09-19","2024-10-10","2024-10-24","2024-10-24","2024-12-24","2025-10-28","2025-10-28","2024-02-26","2024-09-16","2025-03-17","2024-12-04","2024-03-29","2024-06-06","2024-04-15","2024-04-15","2024-04-15","2024-04-15","2024-05-21","2024-04-15","2024-04-19","2024-05-21","2024-05-21","2024-07-15","2024-07-15","2024-07-15","2024-08-21","2024-08-21","2024-09-09","2024-05-14","2024-10-16","2024-10-16","2024-10-16","2024-10-16","2024-12-24","2024-12-24","2024-12-18","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":[["","","METFORMIN HCL","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ESTRADIOL (TWICE WEEKLY)","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","SOD SULF-POTASS SULF-MAG SULF","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CARISOPRODOL","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","AMOXICILLIN","","","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":""}]}]}