{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Kerri A Fish","gend":1,"currentgend":"","add":"130 ROCKLAND ST","city":"NEW BEDFORD","state":"MA","zip":"02740","dob":"1994-05-20","age":"","mstatus":"","insh":"C0008720100","cliId":"","pno":7745102821,"cno":"","email":"","ename":"","eno":"","pphy":"Shan Qin","ppno":5089963991,"pcpadd":"535 Faunce Corner Rd,","pcpcity":"North Dartmouth","pcpstate":"MA","pcpzip":"02747","pcpcounty":"","pcpid":"","pcpname":"Lifespan Physician Group of Massachusetts, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"APT 1","add3":"","madd1":"130 ROCKLAND ST","madd2":"APT 1","madd3":"","mcity":"NEW BEDFORD","mstate":"MA","mzip":"02740","pcpfaxno":"","pcpnpi":1891138822,"currentgendcomment":"","pphycomment":"","uniqueid":68171750,"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","R519","N760","A493","N390","Z634","J45909","B3731","Z760","B49","R112","B002","N898","F419","R109","Z20822","N10","N151","B9620","E876","R0789","R0602","I252","Z87891","L02211","L03031","R1030","Z1152","F439","R9341","N83202","N12","Z98890","R399","Z202","K219","F900","R87610","Z6826","Z0189","Z113","R102","R7303","R252","Z0000","N9489","R350","N925","R8290","R079","R1031","R1032","R110","Z0100","Z789","Z7689","R5383","R059","R1085","K5100","L600","R9431"],"date":["2025-12-10","2025-12-28","2025-11-04","2024-06-06","2025-11-11","2025-03-18","2025-11-29","2025-09-05","2025-04-02","2024-11-22","2025-12-10","2025-06-19","2025-07-21","2025-10-10","2025-12-10","2025-08-02","2024-10-03","2024-10-03","2024-07-03","2024-10-03","2025-08-02","2025-08-02","2025-08-02","2025-08-02","2025-05-09","2025-09-28","2025-12-10","2025-12-10","2025-12-09","2024-06-03","2024-07-03","2024-07-03","2024-05-04","2024-11-09","2025-02-17","2025-10-10","2025-10-10","2025-03-18","2025-03-18","2024-11-09","2025-01-17","2024-11-09","2024-04-10","2024-04-10","2025-10-10","2024-05-11","2025-05-30","2025-01-17","2025-03-11","2025-08-02","2024-05-03","2024-05-03","2024-05-03","2025-10-07","2025-03-18","2025-03-06","2025-06-10","2025-12-10","2025-12-10","2025-12-10","2025-10-10","2025-12-10"],"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":[["","","ONDANSETRON ODT","","","Select","Select",""],["","","CEFPODOXIME PROXETIL","","","Select","Select",""],["","","IBUPROFEN","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","NITROFURANTOIN MONO-MACRO","","","Select","Select",""],["","","ALPRAZOLAM","","","Select","Select",""],["","","VENTOLIN HFA","","","Select","Select",""],["","","FLUCONAZOLE","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","AZITHROMYCIN","","","Select","Select",""],["","","BENZONATATE","","","Select","Select",""],["","","ONDANSETRON HCL","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","VALACYCLOVIR","","","Select","Select",""],["","","CLINDAMYCIN HCL","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","NITROFURANTOIN","","","Select","Select",""],["","","OXYCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","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":""}]}]}