{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jessica Goode","gend":1,"currentgend":"","add":"93 BASS POINT RD","city":"NAHANT","state":"MA","zip":"01908","dob":"1989-11-06","age":"","mstatus":"","insh":"C0031369900","cliId":"","pno":"6179741245","cno":"","email":"","ename":"","eno":"","pphy":"David W Douglas","ppno":"7815936005","pcpadd":"330 Lynnway, Ste 109A","pcpcity":"Lynn","pcpstate":"MA","pcpzip":"01901","pcpcounty":"","pcpid":"","pcpname":"Congenial Healthcare, LLC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"93 BASS POINT RD","madd2":"","madd3":"","mcity":"NAHANT","mstate":"MA","mzip":"01908","pcpfaxno":"","pcpnpi":"1154340420","currentgendcomment":"","pphycomment":"","uniqueid":"141404100","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","F10129","F10139","S0990XD","S0990XA","R9431","W19XXXD","Y908","F4310","F1021","J0190","F902","F411","F17200","F419","F1020","F10120","S0081XA","S50312A","Z609","R569","Z5181","H9203","H9193","H6123","S199XXA","M25421","M25522","R5383","T148XXA","R4182","F10920","V878XXA"],"date":["2026-05-20","2025-12-23","2025-12-23","2025-12-23","2025-12-21","2025-12-21","2025-12-21","2025-12-21","2026-01-10","2026-01-10","2026-03-16","2026-05-06","2026-04-09","2026-05-06","2026-05-06","2026-05-06","2024-09-03","2024-09-18","2024-09-18","2024-09-18","2025-01-23","2025-01-23","2024-07-26","2024-07-26","2024-07-26","2024-09-16","2024-09-16","2024-09-16","2024-09-03","2024-09-16","2024-09-03","2024-09-04","2024-09-18"],"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":[["","","CITALOPRAM HBR","","","Select","Select",""],["","","TOPIRAMATE","","","Select","Select",""],["","","QUETIAPINE FUMARATE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","BUPROPION XL","","","Select","Select",""],["","","AZELASTINE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","DEXTROAMPHETAMINE-AMPHET ER","","","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":""}]}]}