{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kayla M Hicks","gend":1,"currentgend":"","add":"1 KINGSTON COLLECTION WAY","city":"KINGSTON","state":"MA","zip":"02364","dob":"1997-02-18","age":"","mstatus":"","insh":"C0038500500","cliId":"","pno":"7742831598","cno":"","email":"","ename":"","eno":"","pphy":"Amanda C Costa","ppno":"5088940400","pcpadd":"1215 Broadway","pcpcity":"Raynham","pcpstate":"MA","pcpzip":"02767","pcpcounty":"","pcpid":"","pcpname":"Signature Healthcare Medical Group, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"APT 104","add3":"","madd1":"1 KINGSTON COLLECTION WAY","madd2":"APT 104","madd3":"","mcity":"KINGSTON","mstate":"MA","mzip":"02364","pcpfaxno":"","pcpnpi":"1841541109","currentgendcomment":"","pphycomment":"","uniqueid":"152893850","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":["E282","E669","E88819","R99","E6601","Z7984","Z6841","Z79899","Z0000","E559","D229","F419","F32A","J45909","G43909","Z6836","Z91018","Z6837","J329","H6123","K131","R7989","R0981","K1370","J0100","Z7951","Z8249","R509","R519","J029","E281","R61","L852","M79671","M79672"],"date":["2026-03-17","2026-04-22","2026-04-22","2026-02-11","2025-10-31","2025-08-26","2025-10-31","2025-08-26","2026-01-05","2026-01-05","2026-01-05","2026-01-05","2026-01-05","2026-01-05","2026-01-05","2026-01-05","2026-02-06","2026-01-08","2026-02-06","2026-02-06","2025-07-29","2025-07-29","2026-02-04","2025-09-08","2025-09-28","2026-01-08","2026-01-05","2026-02-04","2026-02-04","2026-02-04","2025-05-15","2025-05-15","2025-05-22","2025-05-22","2025-05-22"],"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":[["","","METFORMIN HCL ER","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","SUMATRIPTAN SUCCINATE","","","Select","Select",""],["","","PHENTERMINE HCL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","EPINEPHRINE","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","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":""}]}]}