{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Casey Trapp","gend":1,"currentgend":"","add":"20 QUAIL RUN RD","city":"BRIDGEWATER","state":"MA","zip":"02324","dob":"1990-01-08","age":"","mstatus":"","insh":"C0031467900","cliId":"","pno":"6176942890","cno":"","email":"","ename":"","eno":"","pphy":"Jennifer  Richardson","ppno":"5089417100","pcpadd":"1 Donalds Way","pcpcity":"East Bridgewater","pcpstate":"MA","pcpzip":"02333","pcpcounty":"","pcpid":"","pcpname":"Signature Healthcare Medical Group, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"20 QUAIL RUN RD","madd2":"","madd3":"","mcity":"BRIDGEWATER","mstate":"MA","mzip":"02324","pcpfaxno":"","pcpnpi":"1083846760","currentgendcomment":"","pphycomment":"","uniqueid":"141546950","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":["Z01419","N760","N6310","Z1389","N6341","F3281","R99","M5450","S0511XA","S20219A","S301XXA","M533","R110","R911","J45909","M25542","R079","R1031","R1032","S0081XA","S30811A","M25512","M25552","M25551","M79645","N939","M79642","V892XXA","R102","R519","M542","R7989","S322XXA","S20214A","R0789","S60512A","S299XXA","R109","M549","S3991XA"],"date":["2025-10-09","2025-12-03","2026-05-04","2026-05-04","2026-05-12","2024-09-18","2024-10-03","2024-10-07","2024-10-02","2024-10-02","2024-10-02","2024-10-02","2024-10-02","2024-10-02","2024-10-02","2024-09-26","2024-10-02","2024-09-26","2024-09-26","2024-09-26","2024-09-26","2024-09-26","2024-09-26","2024-09-26","2024-11-12","2024-07-31","2024-09-26","2024-10-02","2024-09-26","2024-09-26","2024-09-26","2024-10-02","2024-10-02","2024-10-02","2024-10-02","2024-09-26","2024-09-26","2024-09-26","2024-09-26","2024-09-26"],"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":[["","","SIMPESSE","","","Select","Select",""],["","","METHOCARBAMOL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","LIDOCAINE","","","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":""}]}]}