{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Richard Carolan","gend":0,"currentgend":"","add":"22 COOK ST","city":"DRACUT","state":"MA","zip":"01826","dob":"1983-08-20","age":"","mstatus":"","insh":"C0027405600","cliId":"","pno":"9785053904","cno":"","email":"","ename":"","eno":"","pphy":"Raymond H Lewis","ppno":"9788514141","pcpadd":"600 Clark Rd","pcpcity":"Tewksbury","pcpstate":"MA","pcpzip":"01876","pcpcounty":"","pcpid":"","pcpname":"LGH Medical Group, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"22 COOK ST","madd2":"","madd3":"","mcity":"DRACUT","mstate":"MA","mzip":"01826","pcpfaxno":"","pcpnpi":"1114901030","currentgendcomment":"","pphycomment":"","uniqueid":"132840750","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":["F419","I429","R99","I110","I150","Z720","E7800","I5021","R0989","I420","R001","R0609","I7409","I6522","Z20822","J101","R0602","J441","R058","R509","R0902","I517","R079","E876","I129","N1830","I2510","I739","R451","I10","N1832","F19982","H5213","H35033","R9431","N189","R052","F19950","F19150","I428","R062","F1290","F17210","Z79899","Z1152","Z7952","Z7982","F1090","E663","F1320","Z0000","Z1331","I119"],"date":["2025-07-01","2025-08-07","2026-05-19","2026-05-11","2026-05-17","2025-10-20","2026-05-19","2026-05-26","2025-10-28","2025-09-25","2025-09-25","2025-09-25","2025-09-25","2025-10-28","2025-02-07","2025-02-07","2025-02-25","2025-02-26","2025-02-15","2025-02-15","2025-02-23","2025-02-22","2025-02-22","2025-02-23","2025-02-26","2025-02-23","2025-02-23","2025-02-22","2025-02-25","2025-02-23","2025-03-03","2025-03-03","2025-03-10","2025-03-10","2025-02-22","2025-02-26","2025-03-14","2025-03-14","2025-02-25","2025-02-23","2025-02-08","2025-02-23","2025-02-26","2025-02-26","2025-02-23","2025-02-26","2025-02-26","2025-02-26","2024-12-12","2024-12-12","2024-12-12","2024-12-12","2024-12-12"],"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":[["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","ASPIRIN EC","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","IPRATROPIUM-ALBUTEROL","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","NICOTINE GUM","","","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":""}]}]}