{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jennifer M Plasse","gend":1,"currentgend":"","add":"300 WOODS HOLE RD","city":"FALMOUTH","state":"MA","zip":"02540","dob":"1990-01-02","age":"","mstatus":"","insh":"C0031878600","cliId":"","pno":"7745217833","cno":"","email":"","ename":"","eno":"","pphy":"Stephanie  Delande","ppno":"5087719599","pcpadd":"94 Main St","pcpcity":"Hyannis","pcpstate":"MA","pcpzip":"02601","pcpcounty":"","pcpid":"","pcpname":"Duffy Health Center, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"UNIT 2A","add3":"","madd1":"300 WOODS HOLE RD","madd2":"UNIT 2A","madd3":"","mcity":"FALMOUTH","mstate":"MA","mzip":"02540","pcpfaxno":"","pcpnpi":"1245651322","currentgendcomment":"","pphycomment":"","uniqueid":"142341950","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":["H6993","Z8742","A048","R229","M62838","M25511","G8929","Z302","Z0000","L309","Z8619","F1220","F17210","L84","R200","L819","I10","K582","Z833","M25512","M5412","E7800","Z7902","Z79899","E782","E66813","Z6841","F419","R99","R87612","Z3009","R8789","N390","Z01419","N763","R1011","E876","R112","K760","K8689","K2950","B182","R1084","R140","R3121","R5383","R110","R1030","R109","R1013","Q453","R634","K9289","N939","K621","D128","D126","R319","Z01411"],"date":["2025-07-16","2025-08-13","2025-08-13","2026-01-16","2025-09-19","2025-08-13","2025-08-13","2025-08-22","2026-05-06","2026-01-16","2026-05-06","2026-01-16","2026-03-03","2026-01-16","2026-05-06","2026-05-06","2026-05-29","2026-01-16","2026-01-16","2026-03-03","2026-03-03","2026-03-03","2026-03-03","2026-03-03","2026-05-07","2026-05-06","2026-05-06","2026-04-08","2026-03-03","2025-07-23","2025-08-06","2025-07-23","2024-08-19","2025-06-18","2025-06-18","2024-08-23","2024-08-26","2024-09-02","2024-09-02","2024-09-02","2024-12-31","2024-11-27","2024-11-27","2024-11-27","2025-06-13","2025-06-13","2025-06-13","2025-06-13","2024-08-26","2024-09-23","2024-09-13","2024-09-27","2024-11-27","2024-11-22","2024-11-27","2024-11-27","2024-12-31","2025-06-13","2025-06-18"],"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":[["","","FLUOXETINE HCL","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","KLOR-CON M10","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","BENAZEPRIL HCL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ETONOGESTREL-ETHINYL ESTRADIOL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","TETRACYCLINE HCL","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","NICOTINE GUM","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","CHLORTHALIDONE","","","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":""}]}]}