{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rebeccalee Furtado","gend":1,"currentgend":"","add":"133 GREEN ST","city":"FAIRHAVEN","state":"MA","zip":"02719","dob":"1982-08-13","age":"","mstatus":"","insh":"C0031063700","cliId":"","pno":"7743051780","cno":"","email":"","ename":"","eno":"","pphy":"David S Chesney","ppno":"5087583781","pcpadd":"208 Mill Rd","pcpcity":"Fairhaven","pcpstate":"MA","pcpzip":"02719","pcpcounty":"","pcpid":"","pcpname":"Southcoast Physicians Group, Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"133 GREEN ST","madd2":"","madd3":"","mcity":"FAIRHAVEN","mstate":"MA","mzip":"02719","pcpfaxno":"","pcpnpi":"1396732418","currentgendcomment":"","pphycomment":"","uniqueid":"140686550","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","M25551","R252","Z1231","Z0000","G43109","F429","R61","F411","F410","F4312","F40298","F4310","M5431","M5441","D509","D529","R1312","F17210","H04123","G43B0","H524","M51360","M9903","M160","K2990","M5417","M5416","M5450","R5383","R1310","F331","F428","F419","Z91018","J310","R1311"],"date":["2026-05-25","2026-02-01","2025-08-20","2025-10-25","2025-11-26","2025-11-26","2026-05-08","2026-05-08","2026-05-08","2026-05-08","2026-05-08","2026-05-08","2026-05-08","2026-02-01","2026-03-31","2026-05-08","2026-05-08","2025-09-03","2025-11-06","2025-11-25","2025-11-25","2025-12-17","2026-03-18","2026-03-18","2026-02-01","2026-04-01","2026-04-16","2026-04-16","2026-04-16","2025-03-12","2025-05-01","2025-03-05","2025-06-27","2025-03-28","2025-05-05","2025-05-05","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":[["","","PAROXETINE HCL","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","CLOMIPRAMINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","PREDNISOLONE SODIUM PHOSPHATE","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","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":""}]}]}