{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Diana Devine","gend":1,"currentgend":"","add":"52 NORTH ST","city":"MIDDLEBORO","state":"MA","zip":"02346","dob":"1997-12-15","age":"","mstatus":"","insh":"C0027596100","cliId":"","pno":"7749924270","cno":"","email":"","ename":"","eno":"","pphy":"Carol N Hamilton","ppno":"5088225500","pcpadd":"1 Washington St","pcpcity":"Taunton","pcpstate":"MA","pcpzip":"02780","pcpcounty":"","pcpid":"","pcpname":"Manet Community Health Center, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"APT 4","add3":"","madd1":"52 NORTH ST","madd2":"APT 4","madd3":"","mcity":"MIDDLEBORO","mstate":"MA","mzip":"02346","pcpfaxno":"","pcpnpi":"1740840610","currentgendcomment":"","pphycomment":"","uniqueid":"133525050","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":["E669","F418","J4530","L03316","B373","N760","G4733","B3781","R99","J4540","J09X2","S0990XA","F331","F411","F603","Z6833","R7303","R110","B3731","N9489","E663","Z6829","Z23","B370","Z6830","S060X0A","W0110XA","Z9109","R051","Z6835","Z124","Z0000","R0683","F39","L0390","S139XXA"],"date":["2026-02-11","2025-08-31","2025-12-08","2025-10-10","2025-10-20","2025-10-25","2026-02-11","2025-11-05","2026-04-22","2026-03-23","2026-04-13","2026-02-24","2026-04-22","2026-04-22","2026-04-22","2025-08-01","2025-08-01","2025-08-01","2025-10-20","2025-10-20","2026-01-30","2025-10-31","2025-10-31","2025-11-05","2026-01-30","2026-02-24","2026-02-24","2026-02-11","2026-04-13","2025-05-02","2024-12-31","2024-12-31","2025-04-03","2024-08-16","2024-08-16","2025-02-05"],"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":[["","","FLUOXETINE HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","NYSTATIN","","","Select","Select",""],["","","ALBUTEROL SULFATE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","TRULICITY","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","NEOMYCIN-POLYMYXIN-HC","","","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":""}]}]}