{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Penelope F Randolph","gend":1,"currentgend":"","add":"45 Depot Road","city":"Truro","state":"MA","zip":"02666","dob":"1965-01-28","age":"","mstatus":"","insh":"C0034471300","cliId":"","pno":"5083491631","cno":"","email":"","ename":"","eno":"","pphy":"Barbara K Prazak","ppno":"5083493131","pcpadd":"3130 State Hwy Rte 6","pcpcity":"Wellfleet","pcpstate":"MA","pcpzip":"02667","pcpcounty":"","pcpid":"","pcpname":"Outer Cape Health Services","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"PO Box 1004","madd2":"","madd3":"","mcity":"Truro","mstate":"MA","mzip":"02666","pcpfaxno":"","pcpnpi":"1720190499","currentgendcomment":"","pphycomment":"","uniqueid":"147172500","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":["R99","M25572","D0512","Z1509","Z86000","Z803","Z1239","Z1501","Z79899","W19XXXA","M2012","L821","Z85828","L814","D229","M25579","S99922A","M79672","M65871","M65872","M2011","M2041","M2042","D225","Z872","Z7189","S20161A","W57XXXA","R300","Z79811","Z01419","Z780","Z124","R197","G9331","R9431","Z23","Z0000","Z87311","M818","R5383","N951","R4584","R635","R4189","M810","M150","Z1231","D126","N816","I499","N390","R319"],"date":["2026-02-11","2025-07-21","2026-02-10","2025-12-03","2025-12-03","2025-12-03","2025-12-03","2025-12-03","2026-01-27","2025-07-21","2025-10-03","2025-07-28","2025-07-28","2025-11-13","2025-07-28","2025-07-21","2025-08-08","2025-10-03","2025-10-03","2025-10-03","2025-10-03","2025-10-03","2025-10-03","2025-11-13","2025-11-13","2025-11-13","2025-10-28","2025-10-28","2025-12-05","2026-01-23","2026-01-21","2026-01-21","2026-01-21","2026-01-23","2026-01-23","2026-01-23","2026-01-30","2026-02-10","2026-02-10","2026-02-10","2026-03-17","2026-03-17","2026-03-17","2026-03-17","2026-03-17","2026-03-17","2026-03-17","2025-04-28","2025-01-06","2025-01-06","2025-01-06","2025-03-15","2025-03-15"],"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":[["","","SHINGRIX","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","ALENDRONATE SODIUM","","","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":""}]}]}