{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rhonda M Coni","gend":1,"currentgend":"","add":"2 GATEHOUSE LN","city":"FRANKLIN","state":"MA","zip":"02038","dob":"1976-07-02","age":"","mstatus":"","insh":"C0031045700","cliId":"","pno":"7746022974","cno":"","email":"","ename":"","eno":"","pphy":"Rachel M Kurinsky","ppno":"5086952020","pcpadd":"60 Messenger St","pcpcity":"Plainville","pcpstate":"MA","pcpzip":"02762","pcpcounty":"","pcpid":"","pcpname":"Sturdy Memorial Associates, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"#211","add3":"","madd1":"2 GATEHOUSE LN","madd2":"#211","madd3":"","mcity":"FRANKLIN","mstate":"MA","mzip":"02038","pcpfaxno":"","pcpnpi":"1093132276","currentgendcomment":"","pphycomment":"","uniqueid":"140677550","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":["R99","K5904","J020","G5603","M25561","K5900","J029","Z0000","Z1231","R92323","N6489","R92322","N6012","N950","Z124","Z1151","R939","Z780","Z79899","Z1211","Z860101","D125","K6389","K5730","R7303","F4322","D126","Z0001","Z1331","Z139","Z6828","J4520","G43109","M25532","M5430","R918","R059","R0989","J45901","K5909","J069","R928","M79642","M79641","M19031","M6740","S098XXA","R55","W19XXXA","Y929","M180","R87610","R109","Z860100","K635","K5790","Z6838","M5431","M5432","G43909","R419","E663","M25562","S8390XA"],"date":["2026-02-26","2025-11-03","2024-08-27","2025-02-13","2025-01-09","2025-05-25","2024-09-27","2025-11-03","2024-10-02","2024-10-02","2024-11-14","2024-11-14","2024-11-14","2025-07-03","2025-03-05","2025-02-27","2025-03-13","2025-03-13","2025-05-25","2025-09-25","2025-09-25","2025-09-29","2025-09-25","2025-09-25","2025-11-03","2026-02-12","2024-09-18","2024-08-15","2025-11-03","2024-08-15","2024-08-15","2025-11-03","2024-08-15","2024-08-15","2024-08-15","2024-08-27","2024-09-27","2024-08-27","2024-08-27","2024-09-18","2024-09-27","2024-11-14","2024-11-13","2024-11-13","2024-11-13","2024-11-13","2024-11-22","2024-11-22","2024-11-22","2024-11-22","2025-02-13","2025-03-05","2025-05-25","2025-09-25","2025-09-25","2025-09-25","2025-11-03","2025-11-03","2025-11-03","2025-11-03","2025-11-03","2025-11-03","2026-01-14","2026-01-14"],"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":[["","","CARISOPRODOL","","","Select","Select",""],["","","NORETHINDRONE","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","LINZESS","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","MELOXICAM","","","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":""}]}]}