{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Raymond H Nason","gend":0,"currentgend":"","add":"47 Flora road","city":"Attleboro","state":"MA","zip":"02703","dob":"1968-02-04","age":"","mstatus":"","insh":"C0014985600","cliId":"","pno":5084107368,"cno":"","email":"","ename":"","eno":"","pphy":"Ann Ding","ppno":5086959421,"pcpadd":"170 Draper Ave,","pcpcity":"North Attleboro","pcpstate":"MA","pcpzip":"02760","pcpcounty":"","pcpid":"","pcpname":"Sturdy Memorial Associates, Inc.","plan":"Wellsense Health Plan","program":"ACA","lob":"ACA - Rollover - Wave 1","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"47 Flora road","madd2":"","madd3":"","mcity":"Attleboro","mstate":"MA","mzip":"02703","pcpfaxno":"","pcpnpi":1376034363,"currentgendcomment":"","pphycomment":"","uniqueid":88165500,"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":["Z96651","Z471","E291","N528","L905","Z86006","D225","G4710","R0683","E669","I10","E1169","Z6834","E782","Z7984","G4733","S46012A","S46012D","Z0000","Z23","Z1331","Z139","G4719","M25512","H2510","Z808","E119","R7989","E66811","Z6833","Q6689","R252","I8391","G4730","N5201","D751","M25511","E875","Z0001","R350","M79661","Z1211","Z1212","R99","N529","D2261","F419","C4361"],"date":["2025-11-06","2024-11-03","2025-12-08","2024-12-04","2025-06-30","2025-06-30","2025-06-30","2025-02-13","2024-08-05","2024-08-05","2025-11-08","2025-05-14","2024-05-15","2025-11-08","2025-11-06","2025-11-08","2024-07-30","2024-08-27","2025-07-21","2024-12-18","2025-11-08","2024-05-08","2024-05-08","2025-11-08","2024-11-12","2025-06-30","2025-11-08","2025-11-08","2025-02-13","2025-02-13","2025-03-13","2025-05-14","2025-01-04","2025-01-04","2025-08-18","2025-11-06","2025-11-06","2025-11-08","2025-11-08","2025-11-08","2025-11-08","2025-08-19","2025-08-19","2025-12-25","2025-05-14","2024-07-02","2024-03-18","2024-03-18"],"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":[["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","TESTOSTERONE CYPIONATE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","PAXLOVID","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","KETOCONAZOLE","","","Select","Select",""],["","","LISINOPRIL-HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","TESTOSTERONE","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","SHINGRIX","","","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":""}]}]}