{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kenneth W Tetrault","gend":0,"currentgend":"","add":"440 OLIVER ST","city":"NEW BEDFORD","state":"MA","zip":"02745","dob":"1968-12-20","age":"","mstatus":"","insh":"C0034317400","cliId":"","pno":"4013660159","cno":"","email":"","ename":"","eno":"","pphy":"Jordan C Gularek","ppno":"5089963991","pcpadd":"531 Faunce Corner Rd","pcpcity":"North Dartmouth","pcpstate":"MA","pcpzip":"02747","pcpcounty":"","pcpid":"","pcpname":"Lifespan Physician Group of Massachusetts, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"440 OLIVER ST","madd2":"","madd3":"","mcity":"NEW BEDFORD","mstate":"MA","mzip":"02745","pcpfaxno":"","pcpnpi":"1346571098","currentgendcomment":"","pphycomment":"","uniqueid":"146757450","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":["C61","R99","I10","I2510","N1370","R300","T8149XA","I898","Z9049","Z9079","Z8546","Z79899","Z7982","R188","T8189XA","R350","E785","K219","F419","F17200","Z6829","Z1389","Z0000","Z1211","E66811","Z6831","Z885","Z0001","H9190","Z6830","N4232","H903","J982","Z48816","R100","N5231"],"date":["2026-03-26","2025-12-11","2026-05-25","2026-05-25","2025-07-08","2025-07-08","2025-07-19","2025-07-19","2025-07-19","2026-03-26","2026-02-03","2025-07-19","2025-07-19","2025-07-19","2025-07-19","2025-09-09","2026-02-03","2026-02-03","2025-07-28","2026-02-03","2025-07-28","2025-07-28","2026-02-03","2026-02-03","2026-02-03","2026-02-03","2025-06-10","2025-01-30","2025-01-30","2025-01-30","2025-03-10","2025-05-15","2025-06-10","2025-06-16","2025-06-29","2025-06-16"],"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":[["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ASPIRIN EC","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","TROSPIUM CHLORIDE","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NORMAL SALINE FLUSH","","","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":""}]}]}