{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jhanell Ricketts","gend":1,"currentgend":"","add":"442 W YARMOUTH RD","city":"W YARMOUTH","state":"MA","zip":"02673","dob":"2002-08-07","age":"","mstatus":"","insh":"C0034363100","cliId":"","pno":"5086806460","cno":"","email":"","ename":"","eno":"","pphy":"Lauren E Iacovino","ppno":"5084321400","pcpadd":"710 Route 28","pcpcity":"Harwich Port","pcpstate":"MA","pcpzip":"02646","pcpcounty":"","pcpid":"","pcpname":"Outer Cape Health Services","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"442 W YARMOUTH RD","madd2":"","madd3":"","mcity":"W YARMOUTH","mstate":"MA","mzip":"02673","pcpfaxno":"","pcpnpi":"1639547441","currentgendcomment":"","pphycomment":"","uniqueid":"146869900","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":["Z3402","O283","Z3A36","Z363","O76","O480","O99824","Z370","Z3A41","O9902","D509","D563","Z392","Z0101","B5801","H52221","H5211","G8918","O779","Z391","L2089","R99","Z3403","Z3A29","Z3483","O99820","O4103X0","Z3009","M2550","K029","Z3491","N3000","Z3401","D508","Z3400","Z0100","B589","E559","Z0000","Z13220","M5416","M25562","N926","Z3A01","O99011","Z31430","M25869","E66811","E6609","Z6832","N938","N898","Z3A15","Z3A00"],"date":["2025-09-23","2025-08-26","2025-08-26","2025-09-03","2025-10-01","2025-10-01","2025-10-01","2025-10-01","2025-10-01","2025-10-01","2025-10-01","2025-10-20","2025-10-20","2025-11-29","2025-11-29","2025-11-29","2025-11-29","2025-10-02","2025-10-01","2025-07-15","2025-07-08","2025-10-03","2025-09-23","2025-07-14","2025-08-26","2025-09-04","2025-09-03","2025-11-12","2025-01-24","2025-02-06","2025-04-04","2025-04-10","2025-03-17","2025-05-27","2025-05-20","2024-11-16","2024-11-16","2025-01-07","2025-01-07","2025-01-07","2025-01-22","2025-01-22","2025-02-21","2025-02-21","2025-02-24","2025-03-13","2025-01-07","2025-01-07","2025-01-07","2025-01-07","2024-11-25","2025-04-07","2025-04-07","2025-03-28"],"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":[["","","IBUPROFEN","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","PRENATAL VITAMINS","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","SHAROBEL","","","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":""}]}]}