{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Christina B Morneau","gend":1,"currentgend":"","add":"75 TREMONT ST","city":"SALEM","state":"MA","zip":"01970","dob":"1971-01-05","age":"","mstatus":"","insh":"C0034022000","cliId":"","pno":"8452813351","cno":"","email":"","ename":"","eno":"","pphy":"Hans C Jeppesen","ppno":"9783544611","pcpadd":"55 Highland Hall, Suite 304","pcpcity":"Salem","pcpstate":"MA","pcpzip":"01970","pcpcounty":"","pcpid":"","pcpname":"Charter Health, PC","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"APT 2","add3":"","madd1":"75 TREMONT ST","madd2":"APT 2","madd3":"","mcity":"SALEM","mstate":"MA","mzip":"01970","pcpfaxno":"","pcpnpi":"1669678298","currentgendcomment":"","pphycomment":"","uniqueid":"146394150","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":["M51360","M47816","M5450","G8929","J209","J029","M7918","R0981","R519","R5383","Z6838","H9313","H6123","H903","M25562","Z96652","R399","E669","R9431","R079","I10","M25561","R0789","R002","R61","K219","Z87891","Z79899","H2000","H5711","R110","H33319","H33311","H43811","H3561","H4311","H35413","H539","F411","F3341","R45851","F32A","F1123","F419","F4310","Z634","F329","F1193","G8921","E785","E66812","Z780","Z1231","Z122","E6609","Z0001","R99","F1113","G894","F509","R4584","M1990","E042","Z886","Z91199","Z91041","Z981","Z888","Z881","Z882","Z59869","Z681","F1110","F1111","F331","M461","M4310","S91209A","M62838","N939","R109","N760","B9689","L678","R1032","J1089","R112","R070","J09X9","J189","Z6835","J1000","E860","R0602","R918","R059","R0600","Z042","M25511","M5459","M549","G9081","M4319","M5126"],"date":["2025-07-09","2025-08-05","2026-04-15","2026-04-15","2025-07-24","2025-07-24","2026-02-12","2025-07-24","2025-07-24","2025-07-24","2025-07-24","2025-09-18","2025-09-18","2025-10-23","2025-10-23","2026-01-08","2025-09-24","2026-01-08","2026-01-09","2025-10-16","2026-02-16","2025-10-23","2025-10-16","2025-10-16","2025-10-16","2026-01-08","2026-03-23","2025-10-16","2025-11-05","2025-11-05","2025-11-06","2025-11-06","2026-04-21","2026-04-21","2026-04-21","2025-11-26","2026-04-21","2026-04-21","2026-05-31","2026-04-21","2026-01-14","2026-05-11","2026-01-07","2026-04-07","2026-05-05","2026-01-07","2026-01-11","2026-01-08","2026-01-08","2026-05-11","2026-05-11","2026-03-12","2026-03-11","2026-03-23","2026-05-11","2026-05-11","2026-04-21","2026-01-08","2026-01-08","2026-01-08","2026-01-08","2026-01-08","2026-01-08","2026-01-08","2026-01-08","2026-01-08","2026-01-08","2026-01-08","2026-01-08","2026-01-08","2026-01-08","2026-01-08","2026-02-03","2026-05-05","2025-07-23","2025-07-02","2025-07-12","2025-07-12","2025-07-12","2024-12-27","2024-12-27","2025-01-08","2024-12-27","2025-01-08","2025-01-31","2025-02-03","2025-02-03","2025-02-03","2025-02-09","2025-02-19","2025-02-09","2025-02-19","2025-02-19","2025-02-19","2025-02-19","2025-02-20","2025-02-19","2025-03-28","2025-06-13","2025-04-07","2025-05-24","2025-06-23","2025-06-14","2025-06-14"],"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":[["","","LISINOPRIL","","","Select","Select",""],["","","LORAZEPAM","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","GUAIFENESIN-CODEINE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","MELOXICAM","","","Select","Select",""],["","","ZEPBOUND","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","PREDNISOLONE ACETATE","","","Select","Select",""],["","","HYDROXYZINE PAMOATE","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","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":""}]}]}