{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Renee Price","gend":1,"currentgend":"","add":"162 OGRADY ST","city":"FALL RIVER","state":"MA","zip":"02720","dob":"1974-11-28","age":"","mstatus":"","insh":"C0037913000","cliId":"","pno":"5083456059","cno":"","email":"","ename":"","eno":"","pphy":"William  Blair","ppno":"5089731570","pcpadd":"479 Swansea Mall Dr","pcpcity":"Swansea","pcpstate":"MA","pcpzip":"02777","pcpcounty":"","pcpid":"","pcpname":"Southcoast Physicians Group, Inc","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"APT 1","add3":"","madd1":"162 OGRADY ST","madd2":"APT 1","madd3":"","mcity":"FALL RIVER","mstate":"MA","mzip":"02720","pcpfaxno":"","pcpnpi":"1629428644","currentgendcomment":"","pphycomment":"","uniqueid":"151998700","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","F1120","F419","Z122","F17210","Z0000","R748","L03031","F3289","F32A","Z87891","F329","I10","G4733","E785","Z2821","Z8249","M79675","M19072","M7989","T18128A","I2510","F17200","K2289","K3189","R079","R0602","L02611","L509","Z1231","Z0100"],"date":["2026-04-23","2026-05-15","2026-05-18","2025-12-05","2026-05-03","2025-12-15","2025-12-15","2026-04-23","2025-10-03","2025-10-31","2025-12-05","2025-12-15","2026-05-06","2026-05-03","2025-12-15","2025-12-15","2025-12-15","2026-04-23","2026-04-23","2026-04-23","2026-05-03","2026-05-03","2026-05-03","2026-05-03","2026-05-03","2026-05-03","2026-05-03","2026-04-23","2025-07-15","2025-05-28","2025-05-27"],"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":[["","","HYDROXYZINE HCL","","","Select","Select",""],["","","BUPRENORPHINE-NALOXONE","","","Select","Select",""],["","","CLONIDINE HCL","","","Select","Select",""],["","","FLUOXETINE HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","NALOXONE HCL","","","Select","Select",""],["","","MUPIROCIN","","","Select","Select",""],["","","CEPHALEXIN","","","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":""}]}]}