{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Amber Sirois","gend":1,"currentgend":"","add":"192 THOMAS ST","city":"FALL RIVER","state":"MA","zip":"02723","dob":"2000-02-21","age":"","mstatus":"","insh":"C0028755700","cliId":"","pno":"5089167094","cno":"","email":"","ename":"","eno":"","pphy":"Shannon E Houlihan","ppno":"5089739650","pcpadd":"1030 President Ave, Ste 1001","pcpcity":"Fall River","pcpstate":"MA","pcpzip":"02720","pcpcounty":"","pcpid":"","pcpname":"Southcoast Physicians Group, Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"# 3","add3":"","madd1":"192 THOMAS ST","madd2":"# 3","madd3":"","mcity":"FALL RIVER","mstate":"MA","mzip":"02723","pcpfaxno":"","pcpnpi":"1215561949","currentgendcomment":"","pphycomment":"","uniqueid":"137466650","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":["K611","Z0000","Z1159","F4310","F319","F429","E663","Z713","Z8639","Z9884","Z903","K912","L720","L02411","Z6826","R079","Z719","N946","N920","R0789","Z6825","Z029","Z23","M25511","L0291","N83291","K610","R109","L732","L650","Z7689","F410","F3289","F411","R051","M7501","M7581","M7521","K219","R0602","F419","F32A","R99","F409","E559","E569","D649","Z3009","N942","K769","R7989","Z6828","L570","F40232","K9589","K760","E806","Z9049","Z79899"],"date":["2025-12-21","2026-04-16","2026-04-16","2026-04-22","2026-04-22","2026-04-22","2026-01-30","2025-07-14","2025-07-14","2026-04-15","2025-09-09","2025-09-09","2025-10-13","2025-08-13","2026-01-30","2026-04-15","2025-10-08","2025-10-31","2025-12-02","2026-04-15","2025-10-29","2026-05-12","2025-10-29","2025-11-18","2025-12-18","2025-12-02","2025-12-21","2025-12-21","2026-03-12","2026-03-12","2026-01-30","2026-04-21","2026-04-21","2026-04-22","2026-02-11","2026-04-15","2026-04-15","2026-04-15","2026-04-15","2026-04-15","2026-05-12","2026-05-12","2026-05-28","2026-01-28","2025-09-09","2025-09-09","2025-09-09","2024-12-27","2025-01-13","2024-08-19","2024-08-19","2024-08-19","2024-07-01","2024-08-14","2024-08-14","2025-06-04","2024-09-04","2025-04-03","2025-05-07"],"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":[["","","SPIRONOLACTONE","","","Select","Select",""],["","","FLUZONE TRIVALENT 2024-2025","","","Select","Select",""],["","","JUNEL FE","","","Select","Select",""],["","","TRIAZOLAM","","","Select","Select",""],["","","NEXPLANON","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","CITALOPRAM HBR","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","FLUVOXAMINE MALEATE","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","NORELGESTROMIN-ETH ESTRADIOL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","BUSPIRONE HCL","","","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":""}]}]}