{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Rebecca Pina","gend":1,"currentgend":"","add":"5 FERNWOOD CIR","city":"HARWICH","state":"MA","zip":"02645","dob":"1988-10-07","age":"","mstatus":"","insh":"C0031084200","cliId":"","pno":"5089046483","cno":"","email":"","ename":"","eno":"","pphy":"Andrew  Chin","ppno":"5083493131","pcpadd":"3130 State Hwy Rte 6","pcpcity":"Wellfleet","pcpstate":"MA","pcpzip":"02667","pcpcounty":"","pcpid":"","pcpname":"Outer Cape Health Services","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"5 FERNWOOD CIR","madd2":"","madd3":"","mcity":"HARWICH","mstate":"MA","mzip":"02645","pcpfaxno":"","pcpnpi":"1154889814","currentgendcomment":"","pphycomment":"","uniqueid":"140696950","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":["F902","F331","R5382","F410","F411","D489","M2391","M25561","Z8739","Z0000","Z5181","F900","F332","F349","F1111","D229","G43109","L4050","R42","Z87891","G43719","D225","L219","R99","L710","L400","D235","H8112","H903","H832X3","H838X3","F1110","L980","L821","D485","R21","N760","F32A","G5603","L4059","Z79899","L409","H8111","H832X1","H8303","H52223"],"date":["2026-05-08","2026-05-08","2025-08-18","2026-05-08","2026-05-08","2025-09-29","2025-10-01","2025-10-17","2025-10-17","2025-11-19","2025-11-19","2025-11-19","2025-11-19","2025-11-19","2025-11-19","2025-11-19","2025-11-19","2025-11-19","2025-11-19","2025-11-19","2026-02-26","2025-12-18","2026-04-10","2026-05-08","2025-08-07","2025-09-19","2025-12-18","2025-07-28","2025-07-28","2025-07-28","2025-07-28","2025-08-01","2025-08-07","2025-08-07","2025-09-19","2024-12-18","2025-01-07","2025-06-04","2024-08-08","2024-09-25","2024-09-25","2024-09-25","2024-12-12","2024-11-26","2024-12-12","2025-03-07"],"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":[["","","BUPRENORPHINE-NALOXONE","","","Select","Select",""],["","","LISDEXAMFETAMINE DIMESYLATE","","","Select","Select",""],["","","VYVANSE","","","Select","Select",""],["","","CLOBETASOL PROPIONATE","","","Select","Select",""],["","","PROPRANOLOL HCL","","","Select","Select",""],["","","RIZATRIPTAN","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","EMGALITY PEN","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","BOTOX","","","Select","Select",""],["","","DIAZEPAM","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","BUSPIRONE HCL","","","Select","Select",""],["","","ARIPIPRAZOLE","","","Select","Select",""],["","","CLONAZEPAM","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","BUPROPION HCL","","","Select","Select",""],["","","NALTREXONE HCL","","","Select","Select",""],["","","LAMOTRIGINE","","","Select","Select",""],["","","UBRELVY","","","Select","Select",""],["","","DEXAMETHASONE SODIUM PHOSPHATE","","","Select","Select",""],["","","BETAMETHASONE VALERATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","HYDROXYZINE HCL","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","BUPRENORPHINE 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":""}]}]}