{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mackenzie Watkins","gend":1,"currentgend":"","add":"1264 N MAIN ST","city":"FALL RIVER","state":"MA","zip":"02720","dob":"2001-01-01","age":"","mstatus":"","insh":"C0031190400","cliId":"","pno":"5089742570","cno":"","email":"","ename":"","eno":"","pphy":"Marivyl  Laxer","ppno":"5086365101","pcpadd":"827 American Legion Hwy","pcpcity":"Westport","pcpstate":"MA","pcpzip":"02790","pcpcounty":"","pcpid":"","pcpname":"Southcoast Physicians Group, Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 1","region":"","aligned":"","ano":"","add2":"APT 3","add3":"","madd1":"1264 N MAIN ST","madd2":"APT 3","madd3":"","mcity":"FALL RIVER","mstate":"MA","mzip":"02720","pcpfaxno":"","pcpnpi":"1225093362","currentgendcomment":"","pphycomment":"","uniqueid":"140929950","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":["R197","F900","J40","R21","J22","N760","R195","J4521","F419","J050","J45901","R110","R1010","R5383","Z0000","Z113","J029","Z118","F4310","F4320","F909","F32A","F17210","Z8379","R251","R051","R059","R062","S0031XA","J989","Z720","Z1339","Z23","J4530","E66811","F418","E6609","Z6830"],"date":["2024-10-02","2024-10-03","2025-07-23","2024-10-06","2024-10-09","2024-10-09","2025-07-23","2025-07-30","2025-08-22","2025-08-18","2025-08-18","2025-08-24","2024-06-21","2024-10-02","2025-09-15","2025-09-15","2025-07-23","2025-09-15","2024-06-26","2025-08-12","2025-08-22","2024-05-10","2025-09-15","2024-05-10","2025-07-23","2024-10-09","2024-10-09","2024-10-09","2025-04-29","2025-07-23","2025-07-30","2025-09-15","2025-09-15","2025-09-15","2025-09-15","2025-09-15","2025-09-15","2025-09-15"],"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":[["","","ONDANSETRON HCL","","","Select","Select",""],["","","BUPROPION HCL SR","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","BUDESONIDE-FORMOTEROL FUMARATE","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","BENZONATATE","","","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":""}]}]}