{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Johanna Utley","gend":1,"currentgend":"","add":"67 Sea St","city":"HYANNIS","state":"MA","zip":"02601","dob":"1983-10-05","age":"","mstatus":"","insh":"C0034647900","cliId":"","pno":"7743689577","cno":"","email":"","ename":"","eno":"","pphy":"Angelina  Palombo","ppno":"5087780300","pcpadd":"735 Attucks Ln","pcpcity":"Hyannis","pcpstate":"MA","pcpzip":"02601","pcpcounty":"","pcpid":"","pcpname":"Daniel Driscoll-Neponset Health Center","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"B3","add3":"","madd1":"67 Sea St","madd2":"B3","madd3":"","mcity":"HYANNIS","mstate":"MA","mzip":"02601","pcpfaxno":"","pcpnpi":"1205286143","currentgendcomment":"","pphycomment":"","uniqueid":"147515100","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":["M722","R99","R1032","N83202","Z87891","Z79899","R1022","N80113","N803A2","N83292","K661","Z09","N946","F4320","F419","E782","Z6827","F439","Z3042","Z30011","Z30012","R102","R109","N839","N80391","N809","R059","U071","K2900","M5450","J069","S63642A","R5383","J029","Z3202","Z113","S6992XA","X501XXA","Y9289","Y9389","Z0000","E7800","Z1159","R635","G43009"],"date":["2025-07-23","2026-05-08","2025-10-10","2025-08-31","2025-08-31","2025-08-31","2025-10-10","2025-10-10","2025-10-10","2025-10-10","2025-10-10","2025-10-23","2026-05-08","2025-12-05","2025-12-05","2025-07-23","2025-07-23","2025-07-23","2025-07-25","2025-07-25","2025-07-25","2025-08-31","2025-08-31","2025-08-31","2025-10-10","2025-10-10","2026-01-16","2026-01-16","2026-01-16","2024-12-04","2024-12-23","2025-05-22","2025-06-28","2024-12-23","2025-01-24","2025-01-24","2025-05-13","2025-05-13","2025-05-13","2025-05-13","2025-06-25","2025-06-28","2025-06-28","2025-06-25","2025-06-25"],"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":[["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","NAPROXEN","","","Select","Select",""],["","","LEVONORGESTREL","","","Select","Select",""],["","","NORETHINDRONE","","","Select","Select",""],["","","FLUCELVAX 2025-2026","","","Select","Select",""],["","","SPIKEVAX 2025-2026 (12Y UP)","","","Select","Select",""],["","","HEPLISAV-B","","","Select","Select",""],["","","GARDASIL 9","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","PENICILLIN V POTASSIUM","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","AUROVELA","","","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":""}]}]}