{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Erica Bassett","gend":1,"currentgend":"","add":"364 OAKLAND RD","city":"HYANNIS","state":"MA","zip":"02601","dob":"1985-11-07","age":"","mstatus":"","insh":"C0041868400","cliId":"","pno":"7743927896","cno":"","email":"","ename":"","eno":"","pphy":"Andrew C Jorgensen","ppno":"5087719599","pcpadd":"94 Main St","pcpcity":"Hyannis","pcpstate":"MA","pcpzip":"02601","pcpcounty":"","pcpid":"","pcpname":"Duffy Health Center, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"Commercial - MA - Wave 2","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"364 OAKLAND RD","madd2":"","madd3":"","mcity":"HYANNIS","mstate":"MA","mzip":"02601","pcpfaxno":"","pcpnpi":"1134106271","currentgendcomment":"","pphycomment":"","uniqueid":"158929750","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":["R1116","F12288","E860","J102","E1065","E782","E66813","Z6841","E876","Z9641","F339","Z79899","Z794","Z20828","R112","J101","J4520","Z7902","R918","E109","Z880","I809","E669","R1115","Z6839","H7011","H6691","F331","F419","E1040","F320","R99"],"date":["2026-01-06","2026-01-06","2026-01-01","2026-01-01","2026-05-11","2026-05-11","2026-01-01","2026-05-11","2026-01-06","2026-05-11","2026-01-01","2026-01-06","2026-01-06","2026-01-01","2026-01-06","2026-01-06","2026-01-06","2026-01-06","2026-01-04","2026-01-04","2026-01-04","2026-01-23","2026-05-11","2026-05-11","2026-02-02","2026-03-05","2026-03-29","2026-04-17","2026-04-17","2026-05-11","2026-05-11","2026-05-07"],"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":[["","","HUMALOG","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","HUMALOG KWIKPEN U-100","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","NORTRIPTYLINE HCL","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","OMNIPOD 5 DEXG7G6 PODS (GEN 5)","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","ONDANSETRON ODT","","","Select","Select",""],["","","METOCLOPRAMIDE HCL","","","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":""}]}]}