{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Richard T Hern","gend":0,"currentgend":"","add":"19 VAUGHN CT","city":"STOUGHTON","state":"MA","zip":"02072","dob":"1965-12-16","age":"","mstatus":"","insh":"C0030818600","cliId":"","pno":"5086855969","cno":"","email":"","ename":"","eno":"","pphy":"Tisha N Dickey","ppno":"9785824587","pcpadd":"324 Massachusetts Ave","pcpcity":"Lunenburg","pcpstate":"MA","pcpzip":"01462","pcpcounty":"","pcpid":"","pcpname":"Revere Medical of Massachusetts, P.C.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"19 VAUGHN CT","madd2":"","madd3":"","mcity":"STOUGHTON","mstate":"MA","mzip":"02072","pcpfaxno":"","pcpnpi":"1588984264","currentgendcomment":"","pphycomment":"","uniqueid":"140419250","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":["M9904","M5116","M9903","S335XXA","R99","R0789","I2510","E669","E785","I10","Z9861","I252","Z6836","R7303","N400","Z7982","Z79899","K5900","K5730","K648","E83119","J45909","E7800","F411","E7849","G43909","R079","K5903","N1330","N179","N23","R42","R072","R252","N401","R351","N509","Z0000","Z1211","F419","Z23","A630","Z125","R911","N200","K760","J09X2","R932","R1010","R140","R194","L578","D235","D2361","D2371","D225","L821","M25531","M25532","E83110","M9902","M5417","E559","Z1212","E8310","N521","J4520","R110","R197","M2550","W57XXXA","M79643"],"date":["2026-04-14","2026-04-14","2026-04-14","2026-04-14","2026-05-21","2025-08-07","2026-05-06","2025-07-03","2026-01-14","2026-03-05","2025-07-03","2026-01-14","2025-07-03","2025-07-03","2025-07-03","2025-07-03","2025-07-03","2025-12-19","2026-01-14","2026-01-14","2026-05-06","2026-01-14","2026-01-21","2026-05-06","2026-05-06","2026-05-06","2025-07-03","2025-07-03","2025-07-03","2025-07-03","2025-07-03","2025-07-03","2025-07-02","2025-08-07","2025-12-03","2025-10-08","2025-12-03","2025-11-14","2025-11-14","2025-12-17","2025-11-14","2026-02-27","2025-11-14","2025-12-19","2025-12-19","2025-12-19","2025-12-30","2026-01-07","2026-01-07","2026-01-07","2026-01-14","2026-02-27","2026-02-27","2026-02-27","2026-02-27","2026-02-27","2026-02-27","2025-03-04","2025-03-04","2024-12-24","2024-08-15","2024-11-08","2024-11-08","2024-11-08","2024-11-08","2024-11-08","2024-11-08","2024-10-21","2024-10-21","2025-02-07","2025-02-07","2025-02-07"],"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":[["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","ALFUZOSIN HCL ER","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","NORTRIPTYLINE HCL","","","Select","Select",""],["","","SOLIFENACIN SUCCINATE","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","OSELTAMIVIR PHOSPHATE","","","Select","Select",""],["","","PEG 3350-ELECTROLYTE","","","Select","Select",""],["","","CYCLOBENZAPRINE 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":""}]}]}